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NICE guidelines for imaging studies in children with UTI adequate only in boys under the age of 6 months

Marko Tapani Ristola1, Timo Hurme

  • 1Turku University Hospital, Turku, Finland. mtrist@utu.fi

Pediatric Surgery International
|January 15, 2013
PubMed

Insights

The National Institute for Health and Clinical Excellence (NICE) guidelines for pediatric urinary tract infection (UTI) imaging are only suitable for boys under six months. Applying these guidelines to older children and girls with UTI led to missed diagnoses and unnecessary procedures.

Area of Science:

  • Pediatric Nephrology
  • Urology
  • Medical Imaging

Background:

  • Urinary tract infections (UTIs) are common in young children.
  • Imaging guidelines aim to identify structural abnormalities and prevent renal scarring.
  • The National Institute for Health and Clinical Excellence (NICE) provides guidelines for UTI management in children.

Purpose of the Study:

  • To assess the applicability of NICE guidelines for imaging in children under three with their first UTI.
  • To determine if NICE imaging recommendations accurately identify significant urological findings.

Main Methods:

  • Retrospective cohort study of 112 children under three with a first UTI.
  • Data collected on adherence to NICE guidelines for ultrasonography (US) and voiding cystourethrography (VCUG).
  • Analysis of vesicoureteral reflux (VUR), UTI recurrence, and subsequent urological interventions.

Main Results:

  • Applying NICE guidelines would have missed 52% of VUR cases (including 50% of dilating VUR) and 60% of negative VCUGs.
  • No missed diagnoses were reported in boys under six months.
  • Significant under-diagnosis of VUR and over-diagnosis of need for VCUG were observed in other groups.

Conclusions:

  • NICE guidelines for UTI imaging in children under three are not broadly applicable.
  • Guidelines appear suitable only for boys under six months of age.
  • Current NICE guidelines are insufficient for accurate diagnosis in the broader pediatric UTI population.
Abstract

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