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Voiding Diaries in a High-Volume Voiding Dysfunction Clinic: Evaluation of Clinical Utility and Patient Compliance
Emilie K. Johnson, MD, Kathryn L. Johnson, BA, Ilina Rosoklija, MPH, Stuart B. Bauer, MD, Hiep T. Nguyen, MD, Carlos A. Estrada, MD, Caleb P. Nelson, MD, MPH.
Boston Children's Hospital, Boston, MA, USA.

Introduction: Sparse data exist regarding the clinical effectiveness of voiding diaries (VDs) in real-world settings. We aimed to determine the practical utility of VDs for children with non-neurogenic voiding dysfunction.
Methods: We enrolled patients aged 4-17 years with voiding dysfunction from 7/2012-10/2012. We interviewed families and providers and conducted chart review to assess VD completion, quality, and parent/provider attitudes. Acceptability of a mobile VD was assessed.
Results: 52 patients were interviewed (median age 7 years, 64% female). Of the 42 patients sent a VD, 30 (72%) completed it. Of these, 33% filled out the VD for fewer days than requested and 20% had data gaps. Only 17% of families filled out the diary completely and prospectively. Table 1 summarizes the parent perspective. Notably, 57% of non-completers vs. 17% of completers perceived the VD as inconvenient (p=0.045). Providers felt 87% of reviewed VDs added to their assessment. Despite a positive view by parents/providers, treatment plans for VD completers did not differ from non-completers. Multiple parents recommended a mobile VD without prior suggestion, and 87% expressed interest when directly queried.
Conclusions: Over 2/3 of patients with a voiding pattern abnormality receiving a VD completed it prior to clinic. However, several data quality concerns arose. Patients/providers generally viewed the VD useful. A mobile electronic VD may improve completion rates, data quality, and convenience.
Table 1. Parent perspective of VD - comparison of VD completers vs. non-completers
VD CompletersVD Non-completersp-value
(Fisher exact test)
VD was inconvenient to fill out5/30 (16.7%)4/7 (57.1%)0.045
VD was too long3/30 (10.0%)2/7 (28.6%)0.23
Did not understand the directions1/30 (3.3%)0/8 (0%)1.00
Unsure of child’s voiding habits8/30 (26.7%)6/7 (85.7%)0.007
Did not think VD was important0/30 (0%)0/8 (0%)--
Thought that it could help child30/30 (100%)6/8 (75%)0.040
Filled out diary and forgot to bring0/30 (0%)2/7 (28.6%)0.032


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