000069957 001__ 69957
000069957 005__ 20190709135539.0
000069957 0247_ $$2doi$$a10.5546/aap.2017.eng.e362
000069957 0248_ $$2sideral$$a105127
000069957 037__ $$aART-2017-105127
000069957 041__ $$aeng
000069957 100__ $$aÁlvarez García, N.
000069957 245__ $$aImpact of using an evidence-based clinical guideline for the management of primary vesicoureteral reflux in children
000069957 260__ $$c2017
000069957 5060_ $$aAccess copy available to the general public$$fUnrestricted
000069957 5203_ $$aObjective: To analyze changes in the therapeutic approach at a tertiary care hospital following the implementation of a clinical guideline for the treatment of primary vesicoureteral reflux (VUR) in children. Population and methods: Retrospective study conducted in a cohort of patients with primary VUR (1989-2015) aged 0-15 years at a tertiary care hospital. The therapeutic approach before and after the development of the clinical guideline (2008) was compared. Results: A total of 297 patients (49.8% boys, 50.2% girls) were included; their mean age at the time of diagnosis was 21.71 months. VUR grading was: VUR I-III 45.1%, VUR IV-V 54, 9%; 124 were treated after the implementation of the clinical guideline (group 1), and 173, before (group 2). The mean follow-up period was 124.32 months. A conservative approach was the initial treatment in 70.3% of group 1 patients and 67.9% of group 2 patients. The number of surgeries remains constant (31.45% versus 31.79%), with an increase in the number of endoscopic surgeries (p< 0.005). The profile of patients has changed based on the application of the algorithm proposed by the guideline. Fewer surgeries were done in patients with VUR IV-V (82.32% versus 59.9%, p= 0.000) and there were fewer cases of kidney damage at diagnosis (49.4% versus 9.8%, p= 0.000). Conclusions: The implementation of the clinical guideline has favored an initially conservative approach in patients with severe grade VUR and nephropathy, for whom surgery was traditionally indicated initially. Using clinical guidelines favors a unanimous, evidence-based approach that reduces the performance of unnecessary invasive procedures.
000069957 540__ $$9info:eu-repo/semantics/openAccess$$aby-nc-nd$$uhttp://creativecommons.org/licenses/by-nc-nd/3.0/es/
000069957 590__ $$a0.405$$b2017
000069957 591__ $$aPEDIATRICS$$b118 / 124 = 0.952$$c2017$$dQ4$$eT3
000069957 592__ $$a0.184$$b2017
000069957 593__ $$aPediatrics, Perinatology and Child Health$$c2017$$dQ3
000069957 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/publishedVersion
000069957 700__ $$aDelgado Alvira, R.
000069957 700__ $$aGonzález Ruiz, Y.
000069957 700__ $$aSiles Hinojosa, A.
000069957 700__ $$aFernández Atuan, R.
000069957 700__ $$aRihuete Heras, M.A.
000069957 700__ $$aJusta Roldan, M.
000069957 700__ $$0(orcid)0000-0002-8502-9499$$aGracia Romero, J.$$uUniversidad de Zaragoza
000069957 7102_ $$11004$$2090$$aUniversidad de Zaragoza$$bDpto. Cirugía,Ginecol.Obstetr.$$cÁrea Cirugía
000069957 773__ $$g115, 6 (2017), e362-e369$$pArch. argent. pediatr.$$tArchivos Argentinos de Pediatria$$x0325-0075
000069957 8564_ $$s250520$$uhttps://zaguan.unizar.es/record/69957/files/texto_completo.pdf$$yVersión publicada
000069957 8564_ $$s98987$$uhttps://zaguan.unizar.es/record/69957/files/texto_completo.jpg?subformat=icon$$xicon$$yVersión publicada
000069957 909CO $$ooai:zaguan.unizar.es:69957$$particulos$$pdriver
000069957 951__ $$a2019-07-09-12:06:34
000069957 980__ $$aARTICLE