Initial investigation of childhood urinary tract infection: does the plain abdominal X ray still have a role?

Area of Science:

• Pediatric Radiology
• Diagnostic Imaging
• Urology

Background:

• The plain abdominal X ray (AXR) has been a traditional tool in the initial investigation of childhood urinary tract infections (UTIs).
• Reassessment of its diagnostic yield in the current era of advanced imaging is warranted.
• This study evaluates the utility of AXR in a prospective cohort of children with suspected UTIs.

Observation:

• Data were collected prospectively from 683 children across four pediatric units.
• Renal calculi were identified in five children, all of whom had these detected by ultrasound.
• One renal calculus was not visible on the initial AXR; four spinal abnormalities were noted but did not alter clinical management.

Findings:

• The diagnostic yield of plain abdominal X rays in the initial evaluation of childhood urinary tract infections is low.
• Ultrasound detected all cases of renal calculi, highlighting its superior sensitivity in this context.
• The AXR identified spinal abnormalities that were clinically insignificant, suggesting limited value in routine screening.

Implications:

• The routine use of AXR for initial UTI investigation in children may not be cost-effective or beneficial, considering radiation exposure and minimal clinical impact.
• Expert pediatric ultrasonography should be the primary imaging modality for suspected UTIs.
• AXR should be reserved for specific indications, including hematuria, loin pain, family history of calculus disease, or recurrent UTIs despite a normal ultrasound.