JMIR Publications

ABSTRACT

Background:

Hematuria is one of the most common urologic diseases seen within clinical practice with a prevalence range of 1.7-31.1%. In 2020, new American Urological Association (AUA) guidelines were revised which recommended that following initial evaluation, clinicians should categorize patients into three tiers (low risk, intermediate risk and high risk) based on various factors. Recent literature has shown the AUA guidelines to have high clinical utility when compared to other international guidelines such as the Hematuria Risk Index, Canadian Urological Association and Kaiser Permanente; however, this guideline remains unvalidated amongst the population of “well adults” within the United States.

Objective:

We utilized a retrospective study design to evaluate data abstracted from the electronic medical records of patients seen in the Emory Healthcare Executive Health Clinic from 9/29/2017 to 1/29/2021 to investigate the utility of risk stratification as a tool for clinical decision-making.

Methods:

According to AUA risk stratification system, patients were stratified into low- and intermediate/high-risk groups based on sex, age, smoking history, history of gross hematuria, and RBC/HPF. The frequencies and percentages of different causes of hematuria across the four risk strata were reported

Results:

Of the instances of URBC >=3, 368(41.72%) underwent a repeat analysis within a 6-month time span, 184 (20.86%) within 12-month time span, and 330(37.41%) at > 12 months. Instances of a URBC<3, were more likely to have no urologic diagnosis 1503(91.48%) in comparison to 633 (76.27%) for those instances with a URBC >3. 100% of participants in the LoR group resulted in post urinalysis of no urologic diagnosis versus 75.62% in the InR/HiR group.

Conclusions:

We found a need for a greater focus on monitoring elevated URBC counts, in accordance with clinical guidelines for managing hematuria in low-risk patients. Future research should examine the impact of risk stratification on clinical decisions and access to care, especially in underserved populations. It should also assess how the new AUA guidelines affect physician referral patterns and explore real-world implementation challenges and facilitators