Tuesday, February 11, 2014

Just When You Thought The AAP Guidelines Had Solved How to Evaluate a UTI…

Photo by Aseev Artem via Wikimedia Commons
In 2011, the AAP via our journal published revised evidence-based guidelines for diagnosis and treatment of urinary tract infections in children (doi: 10.1542/peds.2011-1330) that received much attention and resulted in various commentaries, letters to the editor, and subsequent studies to further confirm or not confirm these guidelines.

One recommendation was that a renal and bladder ultrasound should be performed after an initial febrile UTI, and a voiding cystourethrogram should follow if the ultrasound shows an abnormality—and this has been accepted as the standard of practice—at least until Nelson et al. (doi: 10.1542/peds.2013-2109) published their early release study this week looking at almost 4,000 cases where both an ultrasound and VCUG were both performed. The sensitivity, specificity, and predictive values of ultrasound for an abnormal VCUG were determined.

Sadly, in this study, ultrasound proved to be a poor predictor of genitourinary abnormalities and a VCUG was needed even in the setting of a negative ultrasound.

Has this been the case for you? Do you agree with the findings in this study? Share your thoughts below or via an eLetter, Facebook or Twitter, or go with the flow and read an accompanying commentary by Downs et al. (doi: 10.1542/peds.2013-4158) that presents a different take on what we should do for follow-up if we identify a UTI. Read this study and commentary and learn more.

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