title: [A retrospective study to evaluate a protocol aimed at reducing the number of unnecessary voiding cystourethrographies performed after a first episode of febrile urinary tract infection].
abstract: OBJECTIVE
  Whether or not voiding cystourethrography (VCUG) should be performed after a first episode of urinary tract infection (UTI) remains a matter of debate. The role of VCUG is primarily to diagnose high-grade vesicoureteral reflux (≥grade III) (VUR) and hence prevent the development of renal scars and poor long-term outcome. We designed a protocol designed to reduce the indications for performing unnecessary VCUGs after a first episode of febrile UTI. In order to evaluate the efficacy of our protocol, we designed a retrospective study to verify whether high-grade VUR was subsequently being underdiagnosed.
  
  
  METHODS
  This study compared the number of cases of VUR diagnosed over 2 1-year periods in children aged 1 month to 18 years. Data were collected from records held in the pediatric emergency department of the University Hospital of Reims. All cases included had presented to the department with a first episode of febrile UTI. During the first 1-year collection period, all patients underwent a VCUG. During the second collection period, the protocol was in place and VCUG was only performed in children with a serum procalcitonin level greater than 1 ng/L and/or an abnormal renal ultrasound scan.
  
  
  RESULTS
  During the first year, 100 patients underwent routine VCUG and 7 cases of high-grade VUR were diagnosed. During the following year, VCUG was limited according to the new protocol: 102 patients were enrolled, 52 VCUGs were performed and 8 cases of high-grade VUR were diagnosed. Cases of low-grade VUR (I and II) were less frequently detected, without significant consequences for the patients.
  
  
  CONCLUSIONS
  The protocol led to a 40% decrease in the number of VCUGs performed. No cases of high-grade VUR were missed; however, the number of VCUGs performed with a normal outcome remained significant.
authors.affiliation: Service de pédiatrie A, American Memorial Hospital, CHU de Reims, 47, avenue Cognacq-Jay, 51092 Reims cedex, France. caroline.caillaud@chru-strasbourg.fr
authors.forename: C
authors.initials: C
authors.lastname: Caillaud
authors.forename: M
authors.initials: M
authors.lastname: Abély
authors.forename: A
authors.initials: A
authors.lastname: Pons
authors.forename: D
authors.initials: D
authors.lastname: Brunel
authors.forename: M
authors.initials: M
authors.lastname: Viprey
authors.forename: C
authors.initials: C
authors.lastname: Pietrement
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001437:Bacteriuria / Q000000981:diagnostic imaging; D002648:Child; D002675:Child, Preschool; D019091:Critical Pathways; D057210:Delayed Diagnosis / Q000706:statistics & numerical data; D004359:Drug Therapy, Combination; D005260:Female; D005602:France; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D008297:Male; D012189:Retrospective Studies; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*; D001743:Urinary Bladder / Q000000981:diagnostic imaging; D014552:Urinary Tract Infections / Q000000981:diagnostic imaging* / Q000188:drug therapy; D014567:Urography / Q000706:statistics & numerical data*; D014600:Utilization Review / Q000706:statistics & numerical data; D014718:Vesico-Ureteral Reflux / Q000000981:diagnostic imaging*
chemical_list: D000900:Anti-Bacterial Agents