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

Elizabeth W Pingree1, Beth D Harper1, Shanshan Liu2

  • 1Division of General Pediatrics.

Hospital Pediatrics
|September 6, 2023
PubMed

Insights

Voiding cystourethrogram (VCUG) use decreased in infants with urinary tract infections (UTI) after guidelines were issued. This trend continued post-guideline, with fewer vesicoureteral reflux diagnoses and procedures.

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.
Abstract

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