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• W2022382688 abstract "You have accessJournal of UrologyPediatrics: Urinary Tract Infection & Vesicoureteral Relux1 Apr 2014MP44-03 EARLY EFFECT OF AMERICAN ACADEMY OF PEDIATRICS UTI GUIDELINES ON EMERGENCY ADMISSIONS, RADIOGRAPHIC IMAGING AND DIAGNOSIS OF VESICOURETERAL REFLUX Laura S. Merriman, Angela M. Arlen, Jared M. Kirsch, Hal C. Scherz, Edwin A. Smith, Bruce H. Broecker, and Andrew J. Kirsch Laura S. MerrimanLaura S. Merriman More articles by this author , Angela M. ArlenAngela M. Arlen More articles by this author , Jared M. KirschJared M. Kirsch More articles by this author , Hal C. ScherzHal C. Scherz More articles by this author , Edwin A. SmithEdwin A. Smith More articles by this author , Bruce H. BroeckerBruce H. Broecker More articles by this author , and Andrew J. KirschAndrew J. Kirsch More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1378AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives In August of 2011, the American Academy of Pediatrics revised their practice parameters for diagnosis and management of febrile urinary tract infection (fUTI) in children two months to two years of age. Changes in imaging recommendations invigorated an ongoing debate regarding diagnosis and management of vesicoureteral reflux (VUR) in young children. We compared the evaluation of young children with febrile UTI before and after implementation of these guidelines. Methods Two cohorts of children, aged 2 months to 2 years, were assessed in the emergency department setting over two separate six-month periods – from January to June 2011 and January to June 2012 – to evaluate effect of the guidelines. Patient demographics, fever, urine culture, renal/bladder ultrasound, voiding cystourethrogram (VCUG) and admission status were assessed. Children with previous history of VUR or VCUG, prior febrile UTI, undocumented urine culture or afebrile UTI (defined as temperature <101.5 ° F) were excluded. Results There was no significant difference in admissions for febrile UTI before and after guideline implementation (53.4% versus 46.6%, p=.371). There was a 55.6% decrease in VCUGs obtained after initial febrile UTI. Admission rate by VCUG status did not differ between time intervals; the proportion of positive to negative screens remained similar at approximately 1:2 in both 2011 and 2012. Ultrasounds obtained for initial febrile UTI decreased by 17.4%. There was a significant association between US positivity and admission (p<0.0001), with 54.1% in 2011 and 58.3% in 2012 of admitted patients having positive findings. There was no significant correlation between US positivity and VUR detected on VCUG in 2011 (p=0.426) or 2012 (p=0.104). Admitted patients were significantly younger (0.31 years) than those managed as outpatients (0.91 years, p<0.001). Multiple regression analysis confirmed that US positivity, gender and age were all independently predictive of admission. Conclusions The 2011 AAP guidelines clearly impacted management of infants and young children presenting to the emergency department with febrile UTI. The number of VCUGs obtained in this population decreased by more than half. We found no correlation between US and VCUG positivity, calling into question the recommendation to use sonographic findings as the determinant for obtaining additional imaging. Whether foregoing routine VCUG as recommended by the new guidelines will result in increased morbidity due to undiagnosed VUR requires further study. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e443-e444 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Laura S. Merriman More articles by this author Angela M. Arlen More articles by this author Jared M. Kirsch More articles by this author Hal C. Scherz More articles by this author Edwin A. Smith More articles by this author Bruce H. Broecker More articles by this author Andrew J. Kirsch More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ..." @default.
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• W2022382688 title "MP44-03 EARLY EFFECT OF AMERICAN ACADEMY OF PEDIATRICS UTI GUIDELINES ON EMERGENCY ADMISSIONS, RADIOGRAPHIC IMAGING AND DIAGNOSIS OF VESICOURETERAL REFLUX" @default.
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