General Pediatrician Confidence in Managing First-Time Microscopic Hematuria or Proteinuria

Background: Microscopic hematuria and proteinuria are frequently detected in the pediatric population and are often referred to pediatric nephrology. While both can signify renal disease, if either is detected in isolation without other symptoms it is more likely benign. Many articles include algorithms to help pediatricians in the initial workup of hematuria and proteinuria, but there have not been any studies analyzing if providing algorithms or electronic health care record tools improve management confidence. The purpose of this study is to determine pediatrician confidence in management of first-time microscopic hematuria and proteinuria with and without an algorithm. Methods: Pre-intervention surveys (11 questions) were distributed to general pediatric and adolescent medicine clinicians via email with a link to the Qualtrics survey. Epic Smartphrases with the algorithm for isolated microscopic hematuria and isolated proteinuria in afebrile patients between 2-18 years old were made available in Epic to those surveyed with an email announcement in March 2024 (Figure 1). Post-intervention surveys (12 questions) will be distributed after at least six months of intervention. Results: Forty-seven clinicians completed the pre-intervention survey (55%). Clinicians are more confident in interpreting rather than managing microscopic hematuria and proteinuria. For microscopic hematuria, 28%, 49%, and 23% marked confident, some confidence, and little confidence respectively for interpretation compared to 17%, 30%, and 47% for management. For proteinuria, 17%, 60%, and 23% marked confident, some confidence, and little confidence respectively for interpretation compared to 17%, 38%, and 40% for management. Ninety percent of respondents said yes when asked if they would use an Epic Smartphrase algorithm. Conclusion: General pediatricians are more confident in interpreting rather than managing first-time microscopic hematuria and proteinuria. The majority of those surveyed would use an Epic Smartphrase algorithm and this type of intervention warrants further study.