Purpose: Patients' preferences are essential to decision models, cost-effectiveness analyses, and development of clinical practice guidelines. Most pediatric clinical practice guidelines do not account for patient or parental preferences. Parental values pertaining to diagnostic testing for urinary tract infection (UTI) have not been previously assessed.
The objective of this study was to assess parental values for diagnostic testing for potential UTI in children 2-24 months of age, with fever without source.Method: We performed a cross-sectional study of parents of children 2-24 months of age who presented to the emergency department of a tertiary care center. Individual interviews were conducted using utility elicitation. Participants were presented with 5 hypothetical scenarios outlining potential experiences during a child's visit to the Emergency Department. All scenarios described a child who may undergo a urine catheterization to make the diagnosis of UTI. All 5 scenarios described temporary health states as outcomes. Subjects were asked to complete 3 tasks: rank scenarios from "Best" to "Worst", rate these scenarios on a Visual Analog Scale (VAS), and to complete the Chained Standard Gamble (CSG) Exercise. Utilities for each scenario were determined using results from Chained Standard Gamble Technique. Utility means and medians for each of the 5 outcomes were calculated. Nonparametric tests were used to compare utilities between groups of parents.
Result: 117 parents were approached, 81 consented to participate. 68 subjects were included in the final analysis. When ranking the five scenarios, subjects ranked them as was expected by investigators. Results obtained during VAS portion of interview were similar to those obtained during CSG. We found high mean and median utilities for the 5 scenarios. We found no difference in utility values parents of children presenting with fever compared to those of afebrile children or of those parents who had prior experience with urine catheterization compared to those without such experience.
Conclusion: Parents ranking of scenarios suggests that preferences of parents and health care providers are aligned. Parents place high utility values on diagnostic testing for UTI. Presence of fever in the child or parental prior experience with urine catheterization in a child had no significant effect on parents' preferences. When presented with hypothetical scenarios describing fever in a child, parents demonstrated that they prefer to have their child undergo an invasive, uncomfortable procedure over the risk of potential occult UTI.
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