Published online December 1, 2005
PEDIATRICS Vol. 116 No. 6 December 2005, pp. 1613-1614 (doi:10.1542/peds.2005-1914)

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Evidence Does Not Support American Academy of Pediatrics Recommendation for Routine Imaging After a First Urinary Tract Infection

Thomas B. Newman, MD, MPH
Departments of Epidemiology and Biostatistics and Pediatrics,
University of California,
San Francisco, CA 94143

To the Editor.—

Cohen et al¹ recently reported on adherence to American Academy of Pediatrics (AAP) guidelines for imaging after urinary tract infections in the Washington State Medicaid program in 1999–2000. They found that less than one third of children with urinary tract infections diagnosed in the first year after birth received the recommended imaging and that children treated as outpatients were less likely to receive such imaging. They concluded that, "given the trend toward increased outpatient management of urinary tract infections, increased attention to outpatient imaging may be warranted."

However, if something is not worth doing, it is not worth doing well.² The AAP recommendation that young children be imaged with ultrasound and voiding cystourethrography after a first febrile urinary tract infection was based on evidence that was generously labeled as "fair" at the time. In response to a letter questioning the basis for these recommendations,³ Roberts et al of the AAP guideline committee acknowledged that the AAP Executive Board had similar concerns and that the imaging recommendation was "based more on Subcommittee consensus than on evidence."⁴ More recently, Roberts indicated that the imaging recommendations should be reconsidered.⁵

It would be a shame if, as the evidence for routine ultrasonography and voiding cystourethrography is being increasingly questioned,^6–10 the prestige of the authors of this article led clinicians to perceive more, rather than less, need to adhere to the AAP's 1999 imaging recommendations. The lack of adherence reported by Cohen et al is more a cause for celebration than concern.

REFERENCES

1. Cohen AL, Rivara FP, Davis R, Christakis DA. Compliance with guidelines for the medical care of first urinary tract infections in infants: a population-based study. Pediatrics. 2005;115 :1474 –1478[Abstract/Free Full Text]
2. Newman TB. If it's not worth doing, it's not worth doing well [letter]. Pediatrics. 2005;115 :196[Free Full Text]
3. Seidman D. Urinary tract infection guidelines questioned [letter]. Pediatrics. 2000;105 :464
4. Roberts KB, Hellerstein S, Downs SM. Urinary tract infections guidelines questioned [letter]. Pediatrics. 2000;105 :466 –467
5. Roberts KB. Urinary tract infection treatment and evaluation: update. Pediatr Infect Dis J. 2004;23 :1163 –1164[Medline]
6. Wheeler DM, Vimalachandra D, Hodson EM, Roy LP, Smith GH, Craig JC. Interventions for primary vesicoureteric reflux. Cochrane Database Syst Rev. 2004;(3):CD001532
7. Zamir G, Sakran W, Horowitz Y, Koren A, Miron D. Urinary tract infection: is there a need for routine renal ultrasonography? Arch Dis Child. 2004;89 :466 –468[Abstract/Free Full Text]
8. Craig JC, Irwig LM, Knight JF, Roy LP. Does treatment of vesicoureteric reflux in childhood prevent end-stage renal disease attributable to reflux nephropathy? Pediatrics. 2000;105 :1236 –1241[Abstract/Free Full Text]
9. Blumenthal I. Vesicoureteric reflux in children: where next? Lancet. 2005;365 :570 –571[Web of Science][Medline]
10. Hoberman A, Charron M, Hickey RW, Baskin M, Kearney DH, Wald ER. Imaging studies after a first febrile urinary tract infection in young children. N Engl J Med. 2003;348 :195 –202[Abstract/Free Full Text]

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PEDIATRICS (ISSN 1098-4275). ©2005 by the American Academy of Pediatrics

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This Article Extract Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Newman, T. B. Search for Related Content PubMed PubMed Citation Articles by Newman, T. B. Related Collections Infectious Disease & Immunity Social Bookmarking                         What's this?