Practice Variation and Guideline Compliance in Urologic Imaging After Initial Urinary Tract Infection in Children

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology Pub Date : 2025-06-01 DOI:10.1016/j.urology.2025.04.025

Hsin-Hsiao Scott Wang , Anh-Dao Cheng , Jiali Cai , Tenny R. Zhang , Grace Chi , Danielle de Torres , Carlos Estrada , Caleb P. Nelson

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引用次数: 0

Abstract

Objective

To investigate practice pattern variability and drivers of imaging after febrile UTI (fUTI).

Methods

We performed a retrospective review of all children ≤6 years old presenting between 2012 and 2021 who presented in a variety of settings (outpatient, inpatient, emergency department [ED]) with diagnosis of first fUTI to a single freestanding children’s hospital. Patients were excluded if no documented fever, no documented positive urine culture, or history of congenital urinary anomalies. The primary outcome was compliance with American Academy of Pediatrics guidelines regarding genitourinary (GU) imaging after the first or second fUTI. Secondary outcomes were whether patients received GU imaging and the timing of voiding cystourethrogram (VCUG). Multivariate logistic regression was performed.

Results

Four hundred seventy-three patients met criteria with a median age of 11 months. Overall, adherence to American Academy of Pediatrics guidelines was 41%, with no significant increase in compliance over time. Sixty-four percent (306/473) underwent renal-bladder ultrasound (RBUS) after the first fUTI. Of those with abnormal RBUS, 57.1% (44/77) underwent VCUG. Six patients had a VCUG after initial fUTI but no RBUS. Of those with a second fUTI, 36.7% (18/49) underwent VCUG. Notably, 32% received no GU imaging. On multivariate analysis, compliance was associated with younger age (OR 0.98) and inpatient treatment (OR 2.97). The receipt of any imaging was associated with younger age (OR 0.98), female patients (OR 1.78), inpatient treatment (OR 4.98), and private insurance (OR 1.72).

Conclusion

Non-adherence to guidelines on imaging after febrile UTI remains high in the pediatric community, indicating significant potential for improvement.

查看原文本刊更多论文

儿童初次尿路感染后泌尿影像学的实践差异和指南依从性。

目的：探讨发热性尿路感染（fUTI）后影像学表现的实践模式变异性及其驱动因素。方法：我们对2012年至2021年间在一家独立儿童医院（门诊、住院、急诊科[ED]）首次诊断为fUTI的所有≤6岁儿童进行了回顾性研究。排除无发热记录、无尿培养阳性记录或先天性泌尿异常史的患者。主要结果是第一次或第二次fUTI术后泌尿生殖系统（GU）成像是否符合美国儿科学会指南。次要结果是患者是否接受了GU成像和排尿膀胱输尿管造影（VCUG）的时间。进行多元逻辑回归。结果：473例患者符合标准，中位年龄为11个月。总体而言，遵守美国儿科学会指南的比例为41%，随着时间的推移，依从性没有显著增加。64%（306/473）的患者在第一次fUTI后接受了膀胱超声检查。在RBUS异常患者中，57.1%（44/77）行VCUG。6例患者在首次fUTI后出现VCUG，但无RBUS。在第二次fUTI患者中，36.7%（18/49）接受了VCUG。值得注意的是，32%的患者未接受GU显像。在多变量分析中，依从性与年龄较小（OR 0.98）和住院治疗（OR 2.97）相关。接受任何影像学检查与年龄较小（OR 0.98）、女性患者（OR 1.78）、住院治疗（OR 4.98）和私人保险（OR 1.72）相关。结论：在儿科社区，不遵守热性尿路感染后影像学指南的情况仍然很高，这表明有很大的改善潜力。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Urology 医学-泌尿学与肾脏学

CiteScore

3.30

自引率

9.50%

发文量

716

审稿时长

59 days

期刊介绍： Urology is a monthly, peer–reviewed journal primarily for urologists, residents, interns, nephrologists, and other specialists interested in urology The mission of Urology®, the "Gold Journal," is to provide practical, timely, and relevant clinical and basic science information to physicians and researchers practicing the art of urology worldwide. Urology® publishes original articles relating to adult and pediatric clinical urology as well as to clinical and basic science research. Topics in Urology® include pediatrics, surgical oncology, radiology, pathology, erectile dysfunction, infertility, incontinence, transplantation, endourology, andrology, female urology, reconstructive surgery, and medical oncology, as well as relevant basic science issues. Special features include rapid communication of important timely issues, surgeon''s workshops, interesting case reports, surgical techniques, clinical and basic science review articles, guest editorials, letters to the editor, book reviews, and historical articles in urology.