title: Impact of a more restrictive approach to urinary tract imaging after febrile urinary tract infection.
abstract: OBJECTIVE
  To determine the impact of using an algorithm requiring selective rather than routine urinary tract imaging following a first febrile urinary tract infection (UTI) on imaging use, detection of vesicoureteral reflux (VUR), prophylactic antibiotic use, and UTI recurrence within 6 months.
  
  
  METHODS
  Retrospective review comparing outcomes during periods before algorithm use (September 1, 2006, to August 31, 2007) and after algorithm use (September 1, 2008, to August 31, 2009). The new algorithm, which adapted recommendations from the United Kingdom's National Institute for Health and Clinical Excellence 2007 guidelines, was implemented in 2008. The algorithm calls for renal ultrasonography in most cases and restricts voiding cystourethrography for use in patients with certain risk factors.
  
  
  METHODS
  County health system.
  
  
  METHODS
  Children younger than 2 years with a first febrile UTI.
  
  
  METHODS
  Selective algorithm for urinary tract imaging.
  
  
  METHODS
  Urinary tract imaging use, detection of VUR, prophylactic antibiotic use, and UTI recurrence within 6 months.
  
  
  RESULTS
  After introduction of the new algorithm, voiding cystourethrography and prophylactic antibiotic use decreased markedly. Rates of UTI recurrence within 6 months and detection of grades 4 and 5 VUR did not change, but detection of grades 1 to 3 VUR decreased substantially. Patients in the prealgorithm group with grades 1 to 3 VUR who would have been missed with selective screening underwent no interventions other than successive urinary tract imaging and prophylactic antibiotic use.
  
  
  CONCLUSIONS
  By restricting urinary tract imaging after an initial febrile UTI, rates of voiding cystourethrography and prophylactic antibiotic use decreased substantially without increasing the risk of UTI recurrence within 6 months and without an apparent decrease in detection of high-grade VUR. Clinicians can be more judicious in their use of urinary tract imaging.
authors: Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, CA 95128, USA. Alan.Schroeder@hhs.sccgov.org
authors: Alan R
authors: AR
authors: Schroeder
authors: Jennifer M
authors: JM
authors: Abidari
authors: Rashmi
authors: R
authors: Kirpekar
authors: John R
authors: JR
authors: Hamilton
authors: Young S
authors: YS
authors: Kang
authors: VyThao
authors: V
authors: Tran
authors: Stephen J
authors: SJ
authors: Harris
mesh_terms: D000465:Algorithms; D019072:Antibiotic Prophylaxis; D002140:California; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D017063:Outcome Assessment, Health Care; D018579:Patient Selection; D012008:Recurrence; D012189:Retrospective Studies; D014463:Ultrasonography; D014552:Urinary Tract Infections / Q000000981:diagnostic imaging*; D014567:Urography / Q000706:statistics & numerical data; D014718:Vesico-Ureteral Reflux / Q000517:prevention & control