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Ordering of renal tract imaging by paediatricians after urinary tract infection
Gabrielle Williams1, Premala Sureshkumar, Siew F Chan
1Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, and Screening and Test Evaluation Program, School of Public Health, University of Sydney, Sydney, New South Wales, Australia. gabriew4@chw.edu.au
Insights
Pediatricians consistently use ultrasound for kidney imaging after urinary tract infections. However, ordering of more invasive tests like micturating cystourethrogram (MCU) and dimercaptosuccinic acid (DMSA) scans varies significantly by child
Area of Science:
- Pediatric Nephrology
- Diagnostic Imaging Practices
- Clinical Decision-Making
Background:
- Urinary tract infections (UTIs) are common in children.
- Renal tract imaging is often used to evaluate UTIs.
- Understanding current imaging practices is crucial for guideline development.
Purpose of the Study:
- To describe reported ordering patterns of renal tract imaging by pediatricians following pediatric UTIs.
- To investigate variations in imaging modality selection based on clinical factors.
Main Methods:
- A piloted, self-administered survey was distributed to 354 randomly sampled Australian pediatricians.
- Participants responded to 12 clinical scenarios varying in age, gender, and fever.
- Likelihood of ordering renal ultrasound, micturating cystourethrogram (MCU), and dimercaptosuccinic acid (DMSA) scans was reported on a 0-100% scale.
Main Results:
- The survey achieved a 74.6% response rate.
- Ultrasound was universally ordered (100%) across all scenarios.
- MCU ordering was high in infants but decreased with age and fever; DMSA ordering also decreased with age and fever, showing significant variability.
Conclusions:
- Pediatricians demonstrate consistent use of ultrasound, the least invasive imaging modality, for UTIs.
- Significant variability exists in the reported use of more invasive tests (MCU, DMSA).
- Ordering of MCU and DMSA is influenced by patient age and the presence of fever.
Aim:
To describe paediatricians' reported ordering of renal tract imaging of children following urinary tract infection.
Methods:
This is a piloted self-administered survey. A total of 354 randomly sampled practising paediatricians in Australia participated in the survey. The survey included 12 clinical scenarios that varied with age, gender and fever. Respondents indicated their likelihood of ordering renal ultrasound, micturating cystourethrogram (MCU) and dimercaptosuccinic acid scan (DMSA) from 0 to 100%.
Results:
Response rate was 74.6% (264/354). For all clinical scenarios the median probability of ordering an ultrasound was 100% with little variability. For children aged 2 months, likelihood of ordering an MCU was 100%, with little variability, but was 70% for 3-year-olds with fever (45% without fever), and 5% for 6-year-olds with very large variability. Median likelihood of ordering a DMSA was 80% at 2 months, 60% at 3 years and 20% at 6 years (40%, 15%, 5% without fever, respectively). Variability was large for all scenarios and DMSA ordering. Child gender did not influence ordering practices.
Conclusions:
Renal tract imaging practice across paediatricians shows consistent, approximately 100% use of the least invasive modality, ultrasound. In contrast, there is considerable variation in the reported ordering of the more invasive tests MCU and DMSA. Doctors order these tests more in younger children and when fever is present.
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