title: Consequences of following the new American Academy of Pediatrics guidelines for imaging children with urinary tract infection.
abstract: OBJECTIVE
  Urinary tract infections (UTIs) and vesicoureteral reflux (VUR) are assumed to predispose children to renal damage. Awareness of the significance of VUR and the possibility of reducing UTI recurrence and renal damage has warranted guidelines on which patients should undergo imaging after UTI. An authoritative guideline has been issued by the American Academy of Pediatrics (AAP). This study assessed the applicability of the AAP guidelines to a subpopulation of patients with UTI, 2-24-month-old children with febrile UTI.
  
  
  METHODS
  The records of 394 children aged 2-24 months with their first UTI were reviewed. Data were recorded on the indications for renal and bladder ultrasonography (RBUS) and voiding cystourethrography (VCUG) according to the AAP guidelines, RBUS results, VCUG results, use of antimicrobial prophylaxis, antireflux procedures and other urological treatment, and UTI recurrence.
  
  
  RESULTS
  An indication for RBUS was seen in 344 patients. RBUS results were abnormal in 87, including 53 with urinary tract dilatation. An unnecessary RBUS would have been avoided in 43 patients. Seven patients with an abnormal RBUS would not have undergone RBUS. An indication for VCUG was seen in 126 patients. VCUG was performed in 206 patients; VUR was found in 72 patients, including 36 with high-grade VUR. An unnecessary VCUG would have been avoided in 82 patients. High-grade VUR would have been missed in six patients. Five patients would not have undergone surgery.
  
  
  CONCLUSIONS
  The AAP guidelines for imaging studies in children aged 2-24 months with febrile UTI seem applicable to clinical practice.
authors: a 1 Faculty of Medicine, University of Turku , Turku, Finland.
authors: Marko Tapani
authors: MT
authors: Ristola
authors: b 2 Department of Pediatric Surgery, Turku University Hospital , Turku, Finland.
authors: Timo
authors: T
authors: Hurme
mesh_terms: D000047:Academies and Institutes / Q000458:organization & administration; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007668:Kidney / Q000000981:diagnostic imaging; D008297:Male; D010372:Pediatrics / Q000458:organization & administration; D017410:Practice Guidelines as Topic; D011859:Radiography; D014463:Ultrasonography; D014481:United States; D001743:Urinary Bladder / Q000000981:diagnostic imaging; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000382:microbiology / Q000517:prevention & control; D014718:Vesico-Ureteral Reflux / Q000175:diagnosis* / Q000382:microbiology / Q000517:prevention & control
chemical_list: D000900:Anti-Bacterial Agents
keywords: Diagnostic imaging; guidelines; infant; urinary tract infection; vesicoureteral reflux