NICE Guidelines Cannot Be Recommended for Imaging Studies in Children Younger Than 3 Years with Urinary Tract Infection

Abstract

Introduction We assessed the possible consequences of applying the National Institute of Health and Clinical Excellence (NICE) guidelines for imaging studies of children younger than 3 years with urinary tract infection (UTI) to clinical practice, in terms of altered diagnoses and treatment.

Material and Methods In a retrospective cohort of 672 patients with UTI, we evaluated indications for and results of renal and bladder ultrasonography, voiding cystourethrography (VCUG), dimercaptosuccinic acid scintigraphy, UTI recurrence, antimicrobial prophylaxis (AMP), antireflux procedures, and other urological procedures.

Results There were a total 125 patients with vesicoureteral reflux (VUR), of whom 59 patients (47%) would have been missed, had the NICE guidelines being applied. These included 20 of the 64 patients (31%) with dilating VUR and 13 of the 30 patients (43%) who underwent antireflux procedures. A VCUG would have been avoided in 184 patients (74%) with no VUR in VCUG.

Conclusion Based on the results in this cohort of 672 patients, we cannot recommend the use of the NICE guidelines for imaging studies in children younger than 3 years with UTI.

Keywords

urinary tract infections - vesicoureteral reflux - child - NICE guidelines

• References

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