Choosing Wisely:

Don’t perform voiding cystourethrogram routinely in first febrile urinary tract infection (UTI) in children aged two to 24 months.

Rationale and Comments: The risks associated with radiation (plus the discomfort and expense of the procedure) outweigh the risk of delaying the detection of the few children with correctable genitourinary abnormalities until their second UTI.
Sponsoring Organizations:
  • American Academy of Family Physicians
  • Sources:
  • American College of Radiology guidelines
  • National Institute for Health and Clinical Excellence guidelines
  • American Academy of Pediatrics guidelines
  • Disciplines:
  • Urologic
  • Pediatric
  • Infectious disease
  • References: • Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management, Roberts KB. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics. 2011 Sep;128(3):595-610.
    • American College of Radiology , Society for Pediatric Radiology, Society of Nuclear Medicine. ACR-SPR-SNM practice guideline for the performance of adult and pediatric radionuclide cystography [Internet]. Reston (VA): American College of Radiology; 2010. 5 p.
    • National Institute for Health and Clinical Excellence, National Collaborating Centre for Women’s and Children’s Health (UK). Urinary tract infection in children: diagnosis, treatment and long-term management. London: RCOG Press; August 2007. 429 p.
    • Westwood ME, Whiting PF, Cooper J, Watt IS, Kleijnen J. Further investigation of confirmed urinary tract infection (UTI) in children under five years: a systematic review. BMC Pediatrics. 2005 Mar 15;5:2.

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