The accuracy and health risks of a voiding cystourethrogram after a febrile urinary tract infection.
OBJECTIVE
Physicians often defer obtaining a voiding cystourethrogram (VCUG) after the diagnosis of urinary tract infection (UTI) due to concerns regarding increased health risks and inflated rates of vesicoureteral reflux (VUR). This study examines the health risks and accuracy of VCUG testing after diagnosis of a febrile UTI.


METHODS
A retrospective review was conducted of children aged 0-18 years admitted to Nationwide Children's Hospital with a febrile UTI in 1995-2000. Children were divided into two cohorts - those who had a VCUG performed within 1 week of diagnosis (early VCUG cohort) and those who had a VCUG performed more than 1 week after diagnosis (late VCUG cohort). All children were followed for an additional 5 years after hospital discharge.


RESULTS
The incidence and severity of VUR were similar in patients that underwent early and late VCUG testing. Patients who underwent early VCUG testing showed no sign of worsening illness after the test was performed. During the 5-year follow up, these patients did not have higher rates of return emergency department visits or hospital readmission compared to those who received late VCUG testing.


CONCLUSIONS
The rate of VUR detection does not increase with early VCUG testing. Early VCUG testing does not lead to increased risk of bacterial dissemination or urosepsis.
Nationwide Children's Hospital, Department of Pediatrics, Division of Nephrology, 700 Children's Drive, Columbus, OH 43205, USA. john.spencer@nationwidechildrens.org
John David
JD
Spencer
Carlton M
CM
Bates
John D
JD
Mahan
Mary-Lynn
ML
Niland
Shannon R
SR
Staker
David S
DS
Hains
Andrew L
AL
Schwaderer
D000293:Adolescent; D017677:Age Distribution; D015984:Causality; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005334:Fever / Q000175:diagnosis; D005500:Follow-Up Studies; D006305:Health Status Indicators; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D061214:Patient Safety; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D013997:Time Factors; D014521:Urethra / Q000000981:diagnostic imaging*; D001743:Urinary Bladder / Q000000981:diagnostic imaging*; D014552:Urinary Tract Infections / Q000000981:diagnostic imaging* / Q000382:microbiology; D014554:Urination; D014567:Urography / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data*; D014718:Vesico-Ureteral Reflux / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology