Do not perform voiding cystourethrogram (VCUG) routinely in first febrile urinary tract infection (UTI) in children aged 2-24 months.
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.
AAP Clinical Practice Guideline: Urinary Tract Infection: Clinical Practice Guideline for the Diagnosis and Management of the Initial UTI in Febrile Infants and Children 2 to 24 Months. Accessible at: http://pediatrics.aappublications.org/content/128/3/595.full.pdf(pediatrics.aappublications.org).
ACR-SPR Practice Guideline for the Performance of Voiding Cystourethrography in Children. Accessible at: http://www.acr.org/~/media/ACR/Documents/PGTS/guidelines/Voiding_Cystourethrography.pdf(www.acr.org).
National Institute for Health and Clinical Excellence 2007. Urinary tract infection in children: Diagnosis, treatment and long-term management. Accessible at: http://www.nice.org.uk/nicemedia/live/11819/36032/36032.pdf(www.nice.org.uk).
Marie E Westwood, Penny F Whiting, Julie Cooper, Ian S Watt and Jos Kleijnen. Further investigation of confirmed urinary tract infection (UTI) in children under five years: a systematic review. BMC Pediatrics 2005 Mar 15;5:2
This recommendation is provided solely for informational purposes and is not intended as a substitute for consultation with a medical professional. Patients with any specific questions about this recommendation or their individual situation should consult their physician.
The Choosing Wisely®(www.choosingwisely.org) campaign was created as an initiative of the American Board of Internal Medicine (ABIM) Foundation(www.abimfoundation.org) to improve health care quality. More than 50 specialty societies have identified commonly used tests or procedures within their specialties that are possibly overused.
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Voiding Cystourethrogram (VCUG) for First Febrile Urinary Tract Infection in Young Children