title: Guidelines to identify abnormalities after childhood urinary tract infections: a prospective audit.
abstract: OBJECTIVE
  To compare the childhood urinary tract infection (UTI) guidelines from the Royal College of Physicians (RCP) in 1991 and from National Institute of Health and Care Excellence (NICE) (CG54) in 2007 by measuring their efficiency at detecting urinary tract abnormalities.
  
  
  METHODS
  Children with UTIs within the Newcastle Primary Care Trust (population 70,800 children) were referred and imaged according to the RCP guidelines during 2008, and these were compared to the activity that would have been undertaken if we had implemented the CG54 guidelines, including following them through 2011 to identify those with recurrent UTIs.
  
  
  METHODS
  The numbers of children imaged, the imaging burden and efficiency, and urinary tract abnormalities detected by each guideline.
  
  
  RESULTS
  Fewer children would have been imaged by CG54 than RCP (150 vs 427), but its sensitivity was lower, at 44% for detecting scarring, 10% for identifying vesicoureteric reflux and 40% for other abnormalities. Overall, it would have only detected one-quarter of the abnormal cases (8 vs 32) and would have missed five of nine children with scarring, including three with multiple lesions and one with renal impairment. Imposing an age restriction of <8 years to the RCP guidelines would reduce its screening rate by 20% and still detect 90% of the abnormalities.
  
  
  CONCLUSIONS
  The CG54 guidelines do not alter the imaging efficiency compared to the RCP guidelines, but they are considerably less sensitive.
authors.affiliation: Paediatric Nephrology Unit, Great North Children's Hospital, , Newcastle, UK.
authors.forename: Malcolm G
authors.initials: MG
authors.lastname: Coulthard
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Lambert
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Vernon
authors.forename: Elizabeth W
authors.initials: EW
authors.lastname: Hunter
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Keir
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007223:Infant; D007674:Kidney Diseases / Q000175:diagnosis; D008297:Male; D008485:Medical Audit; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D014552:Urinary Tract Infections / Q000000981:diagnostic imaging*; D014718:Vesico-Ureteral Reflux / Q000175:diagnosis
chemical_list: D019275:Radiopharmaceuticals; D019783:Technetium Tc 99m Dimercaptosuccinic Acid
keywords: renal scarring; urinary tract imaging; urinary tract infection; vesicoureteric reflux