Patterns of integration and clinical value of voiding cystourethrography in the work-up of urinary tract infection in children.
OBJECTIVE
To evaluate the patterns of integration and the clinical value of voiding cystourethrography (VCUG) in the imaging work-up of children with urinary tract infection (UTI).


METHODS
We reviewed the medical records of a consecutive sample of 80 children that underwent VCUG as part of routine investigation for UTI. We assessed the following: the appropriateness of integration of VCUG in the patient work-up as determined by the presence or absence of a valid indication for VCUG in the specific clinical situation encountered, the correct timing of the examination and interpretation of its result; the change in clinical management initiated by the result of the test, and the reassurance conferred to the clinician.


RESULTS
Sixty-nine percent of the VCUG examinations were judged appropriately integrated, 14% of the examinations inappropriately integrated, while for the rest of the patients (17%) the appropriateness of integration of the test was rated as unclear. The change in patient management attributable to the VCUG result could be categorized as: no change (15%); decision to end the imaging investigation of the patient (39%); decision to end all investigations, and prophylactic or therapeutic interventions (17%); decision to discontinue chemoprophylaxis (1%); decision to end the imaging investigation and introduce chemoprophylaxis and follow-up for bacteriuria (5%); decision to continue the imaging investigation and introduce chemoprophylaxis and follow-up for bacteriuria (15%), and decision to operate or help in planning the surgical treatment required (8%).


CONCLUSIONS
The findings show the need for an increased effort to minimize overuse of VCUG in pediatric UTI. Future interventions should focus on issues of clinical efficacy of the method that may have not been emphasized sufficiently.
Department of Radiology, Sheffield Children's Hospital, UK.
S
S
Mussurakis
A
A
Sprigg
M
M
Steiner
D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D010372:Pediatrics / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; 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