ArticlePediatric nephrology (Berlin, Germany)2009
Imaging studies for first urinary tract infection in infants less than 6 months old: can they be more selective?
Article in Pediatric nephrology (Berlin, Germany), 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 2 of them syntheses that pooled it.
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Who cites it
11 citing papers in PubMed, 2 syntheses or guidelines pooled it, 45 citations in OpenAlex.
- Dimercaptosuccinic acid scan or ultrasound in screening for vesicoureteral reflux among children with urinary tract infections.The Cochrane database of systematic reviews · 2016Pooled it
- Paediatric urinary tract infections: a retrospective application of the National Institute of Clinical Excellence guidelines to a large general practitioner referred historical cohort.Pediatric radiology · 2014Guideline
- Guidelines for the medical management of pediatric vesicoureteral reflux.International journal of urology : official journal of the Japanese Urological Association · 2020Article
- National Imaging and Antibiotic Practice Patterns in Children Presenting With Urinary Tract Infection to Community Practices: Little Impact From the American Academy of Pediatrics Guidelines?Clinical pediatrics · 2019Article
- Incidence of abnormal imaging and recurrent pyelonephritis after first febrile urinary tract infection in children 2 to 24 months old.The Journal of urology · 2013Article
- NICE guidelines for imaging studies in children with UTI adequate only in boys under the age of 6 months.Pediatric surgery international · 2013Article
- [Diagnostics and therapy of urinary tract infections].Der Urologe. Ausg. A · 2013Article
- Managing urinary tract infections.Pediatric nephrology (Berlin, Germany) · 2011Review
- Febrile urinary tract infection, vesicoureteral reflux, and renal scarring: current controversies in approach to evaluation.Pediatric surgery international · 2011Review
- Evaluating different imaging strategies in children after first febrile urinary tract infection.Pediatric nephrology (Berlin, Germany) · 2010Article
- Urinary tract infections in children: recommendations for antibiotic prophylaxis and evaluation. An evidence-based approach.Current urology reports · 2010Review
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
This retrospective study aimed to evaluate the applicability of the selective approach of imaging infants < 6 months old with urinary tract infection (UTI) according to the UTI guidelines of the National Institute for Health and Clinical Excellence (NICE) 2007. Infants < 6 months old with their first UTI from January 2001 to December 2006 having undergone an ultrasound examination of the urinary tract, a micturating cystourethrogram, and a late di-mercaptosuccinic acid (DMSA) scan, were included. Their condition was evaluated against a set of risk features according to the UTI guidelines. Those having any one of these were classified as atypical and those having none as typical. There were 134 infants reviewed, with a typical (98 infants) to atypical (36 infants) ratio of 2.7 to 1. Girls were found to be relatively more represented in the atypical group [male (M):female (F) = 1.3:1] than in the typical group (M:F = 4.4:1) (P < 0.004). There were significantly more infants with abnormal micturating voiding cystourethrograms (MCUGs) (P = 0.007), more refluxing ureters (P < 0.001) and more significant vesico-ureteral reflux (VUR) (>/= grade III) (P = 0.013) in the atypical group than in the typical group; while there was no significant difference in ultrasound (US) and DMSA scan findings between the two groups. In the atypical group there was no difference in imaging studies (and, thus, the results) between the conventional practice and the NICE UTI recommendation. In the typical group, if the recommendations of the guidelines had been followed (i.e. only those with abnormal US would have been further investigated), 25 refluxing ureters and 22 scarred kidneys would have been left undiagnosed. In conclusion, application of the suggested selective imaging approach would leave a significant number of VUR and renal scars undiagnosed, and it may not be an optimal practice for infants less than 6 months old with their first UTI. The best approach remains to be clarified.
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