The value of ultrasonography as a screening procedure in a first-documented urinary tract infection in children.

Jequier, Sigrid; Forbes, Patricia A.; Nógrády, Miklós

doi:10.7863/jum.1985.4.8.393

Cited by 29 publications

(5 citation statements)

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“…In the present study, the grade of dilatation on ultrasonography was not defined, but it should be noted that dilatation was directly related to the presence and severity of reflux. Renal ultrasonography is usually recommended as a first-line investigation in children with UTI, in order to exclude urinary obstruction (18). This study confirms previous observations that dilatation of the renal pelvis without urinary obstruction frequently indicates the presence of dilated reflux (19).…”

Section: Discussionsupporting

confidence: 89%

Urinary tract infections in children below two years of age: a quality assurance project in Sweden

Hansson

Bollgren

Esbjörner

et al. 1999

SPAE

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The objective of this study was to evaluate the basis for diagnosis and assessment of children <2 y of age with urinary tract infections (UTI) and to describe their subsequent management as currently practised in Sweden. The study was a prospective, multicentre project as part of a programme for quality assurance. A total of 2309 children (1111M, 1198F) was studied during a 2-y period. Of the population at risk, 1.6% of both boys and girls were diagnosed with a UTI. This represents a minimum figure. Suprapubic bladder aspiration was mainly used during the first year of life, with the highest frequency in the youngest infants. Adhesive bags were used in half of the children, and the frequency increased with age. Imaging of the urinary tract was performed in 97% of the children. Vesicoureteric reflux was the most common finding, occurring in 36% of the girls and 24% of the boys. The presence of dilatation of the upper urinary tract correlated significantly to the presence and grade of reflux. Initial intravenous therapy was given to 31% of the children and long-term antibacterial prophylaxis to 20%. Major differences were found between centres in diagnostic rate, urine sampling technique and the use of parenteral therapy. In conclusion, this study showed a high diagnostic rate of urinary infections in children below 2 y of age. The urine sampling technique was optimal (suprapubic aspiration) in half of the infants, but less reliable in the children above 1 y of age. The frequency of imaging investigations of the urinary tract was high. The strategies for diagnosis and treatment varied considerably among centres.

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Section: Discussionsupporting

confidence: 89%

Urinary tract infections in children below two years of age: a quality assurance project in Sweden

Hansson

Bollgren

Esbjörner

et al. 1999

SPAE

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“…Eight studies reporting 17 data sets examined the performance of a variety of tests, and combinations of tests, to detect groups of renal and urinary tract pathologies 122,151,159,161,170,194,203,216 (Table 29). The studies used a wide variety of tests and test combinations as reference standards.…”

Section: Imaging Studies With Multiple Aimsmentioning

confidence: 99%

Clinical effectiveness and cost-effectiveness of tests for the diagnosis and investigation of urinary tract infection in children: a systematic review and economic model

Whiting¹,

Westwood²,

Bojke³

et al. 2006

Health Technol Assess

131

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The results of the systematic review were used to derive an algorithm for the diagnosis of UTI in children under 5. This algorithm represents the conclusions of the review in terms of effective practice. There were insufficient data to propose an algorithm for the further investigation of UTI in children under 5. The quality assessment highlighted several areas that could be improved upon in future diagnostic accuracy studies.

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“…It is prudent to begin the US examination with views of the bladder in the younger child since micturition may occur during the examination, preventing evaluation of the lower ureters later. Numerous studies have shown the high sensitivity and specificity of US as a screening procedure for children with UTI compared with the IVU (Jaquier et al, 1983;Sherwood & Whitaker, 1984;Kangarloo et al, 1985;Whyte et al, 1988). If scarring is detected on US then there is no reason to doubt its existence but a normal US does not exclude a renal scar.…”

Section: Imaging Controversymentioning

confidence: 95%

“…Currently all children with UTI shoud have a plain abdominal radiograph as well as an US of the kidneys and bladder to exclude urinary calculi, nephrocalcinosis and obstructive uropathy, as well as to measure the renal size (Jaquier et al, 1983;Sherwood & Whitaker, 1984;Kangarloo et al, 1985;Whyte et al, 1980). If the US is normal then no further investigations should be undertaken in children older than 5 years.…”

Section: Imaging Controversymentioning

confidence: 96%

Urinary tract infection in paediatrics: the role of diagnostic imaging

Gordon

1990

The British Journal of Radiology

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Infection of the urinary tract (UTI) has several clinical subgroups, each requiring different degrees of investigation. The most severe, acute pyelonephritis, is characterized by ill health, anorexia, pyrexia (>38.5°C), an erythrocyte sedimentation rate greater than 20 mra/h or C-reactive protein greater than 10mg/l, pyuria, bacteruria and possible septicaemia. The child may well require hospitalization and parenteral antibiotics. The term cystitis is used to refer to children with lower urinary tract symptoms but without systemic illness who have more than 100000 bacteria per ml in the urine. They should be distinguished from children who are asymptomatic but nevertheless have positive urine cultures, i.e. asymptomatic bacteruria. This last group usually consists of girls over 5 years old and do not require much investigation. Clinically these three groups overlap to some extent, but nevertheless the presentation should be a guide to the choice of the appropriate imaging. Urinary tract infection is common: the imaging that children undergo is important in terms of resource utilization as well as discomfort and radiation exposure. A conscious effort must be made not to over-investigate the child or to overburden the radiology department, yet treatable disorders or potential long-term complications must be detected (Saxena et al, 1975; Asscher, 1980). A prospective study by Dickson (1979) found 3.1/ 1000 girls and 1.7/1000 boys presented annually with a first symptomatic UTI. The incidence of end-stage renal failure due to pyelonephritis in Europe in individuals under 40 years of age is 4–5 per million per year (Broyer et al, 1984).

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The value of ultrasonography as a screening procedure in a first-documented urinary tract infection in children.

Cited by 29 publications

References 0 publications

Urinary tract infections in children below two years of age: a quality assurance project in Sweden

Urinary tract infections in children below two years of age: a quality assurance project in Sweden

Clinical effectiveness and cost-effectiveness of tests for the diagnosis and investigation of urinary tract infection in children: a systematic review and economic model

Urinary tract infection in paediatrics: the role of diagnostic imaging

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