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ACR Appropriateness Criteria® Urinary Tract Infection-Child
, Boaz K Karmazyn1, Adina L Alazraki2
1Principal Author and Panel Chair, Riley Hospital for Children, Indiana University, Indianapolis, Indiana.
Insights
Urinary tract infections (UTIs) in children often require imaging to detect urologic issues. Guidelines help determine the appropriate imaging for pediatric UTIs, balancing risks and benefits.
Area of Science:
- Pediatric Nephrology
- Diagnostic Imaging
- Urology
Background:
- Urinary tract infections (UTIs) are common in children and can lead to pyelonephritis and renal scarring.
- While long-term complications from renal scarring are minimal, imaging plays a crucial role in identifying underlying urologic abnormalities and guiding treatment.
- Neonates have a higher risk of underlying urologic abnormalities, necessitating careful evaluation.
Purpose of the Study:
- To outline the role of imaging in evaluating pediatric urinary tract infections (UTIs).
- To provide evidence-based guidelines for selecting appropriate imaging studies based on patient age and UTI characteristics.
- To guide clinicians in managing UTIs and associated urologic conditions in children.
Main Methods:
- Review of the American College of Radiology Appropriateness Criteria for pediatric UTI imaging.
- Analysis of current medical literature using established methodologies like RAND/UCLA and GRADE.
- Incorporation of expert opinion to supplement evidence where necessary.
Main Results:
- Ultrasound is generally appropriate for children over 2 months with a first uncomplicated UTI.
- Imaging for vesicoureteral reflux (VUR) is recommended for neonates and children with recurrent or complicated UTIs.
- Routine imaging is not typically needed for children over 6 years with infrequent UTIs, as VUR is less common.
Conclusions:
- Imaging selection for pediatric UTIs should be tailored to the individual child's clinical presentation, age, and risk factors.
- Guidelines help optimize imaging use, ensuring appropriate evaluation for urologic abnormalities while minimizing unnecessary procedures.
- Appropriate imaging guides management, potentially including surgical intervention for conditions like VUR with renal scarring.
Abstract:
Urinary tract infection (UTI) is common in young children and may cause pyelonephritis and renal scarring. Long-term complications from renal scarring are low. The role of imaging is to evaluate for underlying urologic abnormalities and guide treatment. In neonates there is increased risk for underlying urologic abnormalities. Evaluation for vesicoureteral reflux (VUR) may be appropriate especially in boys because of higher prevalence of VUR and to exclude posterior urethral valve. In children older than 2 months with first episode of uncomplicated UTI, there is no clear benefit of prophylactic antibiotic. Ultrasound is the only study that is usually appropriate. After the age of 6 years, UTIs are infrequent. There is no need for routine imaging as VUR is less common. In children with recurrent or complicated UTI, in addition to ultrasound, imaging of VUR is usually appropriate. Renal cortical scintigraphy may be appropriate in children with VUR, as renal scarring may support surgical intervention. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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