Practice variation and guideline compliance in urologic imaging after initial urinary tract infection in children.
Academic Article
Overview
abstract
OBJECTIVE: To investigate practice pattern variability and drivers of imaging after 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, 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 AAP guidelines regarding genitourinary imaging after first or second fUTI. Secondary outcomes were whether patients received genitourinary imaging and timing of VCUG. Multivariate logistic regression was performed. RESULTS: 473 patients met criteria with a median age of 11 months. Overall, adherence to AAP guidelines was 41%, with no significant increase in compliance over time. Sixty-four percent (306/473) underwent 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 genitourinary 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). CONCLUSIONS: Non-adherence to guidelines on imaging after febrile UTI remains high in the pediatric community, indicating significant potential for improvement.
