Related Experiment Video
Updated: Jan 29, 2026
Transurethral Induction of Mouse Urinary Tract Infection
Published on: August 5, 2010
Adherence to the 2011 American Academy of Pediatrics Urinary Tract Infection Guidelines for Voiding Cystourethrogram
Deborah L Jacobson1, Rachel Shannon2, Earl Y Cheng1
1Department of Urology, Northwestern University, Chicago, IL; Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
Insights
Guideline adherence for voiding cystourethrograms was inconsistent, with specialists showing higher adherence. Adherence did not improve detection of abnormalities in young children, suggesting a need to revise current pediatric urinary tract infection imaging guidelines.
Area of Science:
- Pediatric Nephrology
- Urology
- Diagnostic Imaging
Background:
- The American Academy of Pediatrics provides guidelines for voiding cystourethrogram (VCUG) use after urinary tract infections (UTIs) or abnormal renal ultrasounds.
- Current guidelines primarily target children aged 2-24 months, but are often applied to broader age groups.
- The impact of adherence to these VCUG guidelines on detecting vesicoureteral reflux (VUR) is not well-established.
Purpose of the Study:
- To assess adherence rates to established VCUG guidelines in a pediatric population.
- To investigate the association between adherence to VCUG guidelines and the detection of abnormalities, specifically VUR.
- To analyze guideline adherence and outcomes in different age groups, particularly those within the 2-24 month target range.
Main Methods:
- A retrospective review of 365 children who underwent VCUG between January 2012 and December 2013 at a single institution.
- Exclusion of children with pre-existing genitourinary abnormalities.
- Analysis of guideline adherence, VUR detection rates, and associated factors using univariate, multivariate, and subgroup analyses.
Main Results:
- Overall guideline adherence for VCUG ordering was 60.3%, with higher adherence observed among urologists/nephrologists (76.4%) compared to pediatricians/others (51.7%).
- Abnormal VCUG findings were present in 31.8% of all children and 26.2% of those aged 2-24 months.
- Guideline adherence was associated with a higher likelihood of abnormal VCUG results in the overall cohort (P=.02) but not in the 2-24 month subgroup (P=.95).
Conclusions:
- Adherence to VCUG ordering guidelines varies by medical specialty and is not consistently associated with detecting urinary tract abnormalities in children aged 2-24 months.
- The findings suggest that current guidelines may require revision, particularly regarding their application to younger children.
- Further multicenter studies are recommended to validate these findings and inform potential revisions to pediatric UTI imaging recommendations.
Objective:
To evaluate rates of guideline adherence and associations with voiding cystourethrogram result. The American Academy of Pediatrics guidelines recommend voiding cystourethrogram after abnormal renal ultrasound or 2 febrile urinary tract infections. It is unclear whether guideline adherence increases vesicoureteral reflux detection. Additionally, guidelines targeting children 2-24 months are often applied to other ages.
Methods:
Children undergoing voiding cystourethrogram from January 2012 to December 2013 at 1 institution were retrospectively reviewed. Children with known genitourinary abnormalities were excluded. The primary outcome was guideline adherence. Univariate and multivariate analyses were performed. Subgroup analysis of children 2-24 months was completed.
Results:
Voiding cystourethrograms from 365 children were included in the primary analysis, including 187 (51.2%) aged 2-24 months. Overall, 60.3% of voiding cystourethrograms were ordered in accordance with the guidelines. Urologists/nephrologists were more likely to adhere to ordering guidelines than pediatricians/others (76.4% vs 51.7%, odds ratio 3.0 [1.9-4.9], P <.001). Subgroup analysis in children 2-24 months revealed similar findings (76.4% vs 51.5%, odds ratio 3.0 [1.5-6.2], P = .002). Voiding cystourethrograms were abnormal in 31.8% overall and 26.2% aged 2-24 months. Guideline adherence was associated with increased likelihood of abnormal voiding cystourethrogram among all children (P = .02), but not among children 2-24 months (P = .95). Older age, white race, and guideline adherence remained significantly associated with abnormal voiding cystourethrogram in a multiple logistic regression model.
Conclusions:
Guideline adherence was more likely among urologists/nephrologists than pediatricians/others and was not associated with abnormal voiding cystourethrogram among children 2-24 months. Multicenter evaluation is necessary to determine if ordering recommendations should be revised.
Related Concept Videos
01:26Urinary Tract Infection I: Introduction
01:25Urinary Tract Infection II: Pathophysiology
01:17Urinary Tract Infection IV: Nursing Management
01:30Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care
01:28Urinary Tract Calculi I: Introduction
01:28Urinary Tract Calculi V: Nursing Management