Objective: To examine practice changes in conduct of radiological investigations following urinary tract infection (UTI) in children.
Design: Observational study using data from the national Medicare database over the 15 year period July 1993 to June 2008 for four investigations: renal ultrasound (Renal US), micturating cystourethrography (MCU), intravenous pyelography (IVP) and nuclear medicine isotope scanning of the renal tract (NM). Rates per 100,000 children in the age groups 0-4 years and 5 to 14 years were calculated for each test.
Setting: Australian medical practice, including private and public medical settings.
Results: The rates of performance of Renal US remained fairly constant throughout the study period in both age groups, while those for the MCU, IVP, and NM show a strong falling trend over time for each test in both age groups.
For the more invasive tests (MCU, IVP, and NM) the total number performed per annum fell from 11,169 (costing $2,032,621), to 3361 (costing $689,742) in the last ten years.
Conclusion: There have been very marked practice changes over the last 10-15 years. This trend rapidly followed the publication of scientific evidence questioning the benefit of performing these investigations.