National Trends in Voiding Cystourethrograms During Hospitalization for Young Infants With Urinary Tract Infections

Area of Science:

• Pediatric Nephrology
• Diagnostic Imaging
• Infectious Diseases

Background:

• The American Academy of Pediatrics recommended against routine voiding cystourethrogram (VCUG) in infants aged 2-24 months with febrile urinary tract infection (UTI) in 2011.
• The impact of this guideline on VCUG utilization in younger infants (<2 months) remains unclear.

Purpose of the Study:

• To analyze the trend in VCUG performance during hospitalization for infants aged 0-2 months diagnosed with UTI.
• To compare VCUG rates before and after the 2011 AAP guideline.

Main Methods:

• Retrospective cohort study of infants (0-2 months) hospitalized with UTI from 2008-2019 across 38 institutions.
• Utilized piecewise mixed-effects logistic regression to compare preguideline (2008-2011) and postguideline (2012-2019) periods.
• Assessed outcomes including recurrent UTI, vesicoureteral reflux (VUR) diagnosis, and anti-VUR procedures.

Main Results:

• VCUG utilization showed a consistent annual decline of approximately 20% in both preguideline and postguideline periods.
• No significant difference was observed in the postguideline trend of VCUG performance compared to the preguideline period.
• Post-guideline, there was a significant decrease in the diagnosis of VUR and the performance of anti-VUR procedures, with no change in recurrent UTI rates.

Conclusions:

• VCUG utilization during hospitalization for UTI in young infants has declined over the past decade.
• The observed decline in VCUG performance continued post-guideline issuance.
• Further research is necessary to establish optimal imaging strategies for this patient population.