The appropriateness of use and the clinical impact of micturating cystourethrography in paediatric practice.
OBJECTIVE
To determine the appropriateness of use and the clinical impact of micturating cystourethrography (MCU) in paediatric practice.


METHODS
Retrospective medical record review.


METHODS
A major teaching children's hospital in the Trent region.


METHODS
Consecutive sample of 120 children undergoing MCU during 1991-1992, identified from the radiology records.


METHODS
The referring clinician's reasons for requesting an MCU; the clinical management plan pursued before and after the MCU, and the change in management initiated by the result of the examination; the appropriateness of use of the test, as determined by the presence or absence of a valid indication for MCU in the specific clinical situation.


RESULTS
The change in patient management attributable to the MCU result could be categorized as: no change (19%); decision to end the imaging investigation of the patient (33%); decision to end all investigations, and prophylactic or therapeutic interventions (16%); decision to discontinue chemoprophylaxis (2%); decision to end the imaging investigation and introduce chemoprophylaxis and follow-up for bacteriuria (6%); decision to continue the imaging investigation and introduce chemoprophylaxis and follow-up for bacteriuria (13%); and decision to operate or help in planning the surgical treatment required (11%). Inappropriate use of the test was observed in 20% of the cases.


CONCLUSIONS
This study provides a basis for understanding the use of MCU in paediatric practice. The findings that 19% of the cystourethrograms had no appreciable effect, and that 20% of the examinations were used inappropriately show the need for increased effort to minimize overuse of the test.
Department of Radiology, Sheffield Children's Hospital, Western Bank.
S
S
Mussurakis
A
A
Sprigg
G M
GM
Steiner
D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data; D002675:Child, Preschool; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D010347:Patient Care Planning; D012189:Retrospective Studies; D014521:Urethra / Q000000981:diagnostic imaging*; D001743:Urinary Bladder / Q000000981:diagnostic imaging*; D014552:Urinary Tract Infections / Q000000981:diagnostic imaging; D014554:Urination; D014567:Urography / Q000706:statistics & numerical data