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Radiological investigations after urinary tract infection in children: have we changed our practice after the National Institute for Health and Clinical Excellence?
  1. A Talwar,
  2. A Gandhi
  1. Paediatrics, Good Hope Hospital, Birmingham, UK

Abstract

Aims The association between urinary tract infection (UTI) and the development of renal complications has been challenged in recent years. This has prompted the development of new guidelines in August 2007 which suggest a reduction in radiological investigation following UTI; targeting the highest risk groups only. The authors' aims were to audit the conduct of radiological investigations and patient follow-up in children presenting with UTI within our department.

Methods A retrospective case note analysis of infants and children with confirmed UTI (>10 5 cfu/ml) presenting between January 2008 and March 2008 was reviewed.

Results 49 (90% female) infants and children (ranging from 7 weeks to 16 years with a mean age of 5.76 years) were included. The cohort had presented with first presentation (51%), recurrent (33%), atypical (14%) or atypical and recurrent (2%) UTI. 92% of children had an ultrasound in accordance with the guidelines. 7% of these children were found to have abnormalities within the upper urinary tract. 8% had an ultrasound when it was not indicated. No abnormalities were detected in this group. 38% had a DMSA in line with the guidelines and 25% of these children had a pathological discrepancy in renal function. 27% did not have a DMSA when it was indicated. Two children in the cohort qualified for MCUG. Only one child had the investigation which revealed a normal result. 84% of patients were followed up in agreement with the guidelines.

Conclusion The majority of ultrasound scans and patient follow-up within our department are compliant with the new guidelines. However, there is some discrepancy in terms of performing DMSA scans; with the number falling even below the new recommendations. A recent study from Australia confirms a similar change in clinical practice. This suggests that the translation between scientific evidence into clinical practice can occur fairly dramatically. While is it is reassuring to know that there has been no increase in the rates of end stage renal failure among Australians under 25 years over the last decade; it is prudent to remain vigilant about the outcomes in this group of patients over the coming years, subsequent to this change in practice.

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