A new study\u00a0from the\u00a0Advocate Aurora Research Institute\u00a0–\u00a0which is\u00a0part of\u00a0Advocate Health\u00a0–\u00a0published\u00a0Tuesday\u00a0in\u00a0Hospital Pediatrics\u00a0provides guidance for families and physicians caring for infants and young children hospitalized with a\u00a0febrile\u00a0urinary tract infection\u00a0(UTI), one of the most common infections in early childhood.\u00a0<\/p>\n
The findings\u00a0provide insight\u00a0that could reduce the chances of unnecessary tests\u00a0for children\u00a0and\u00a0added stress\u00a0for\u00a0families and\u00a0could\u00a0also\u00a0help shape updated guidelines for pediatricians.\u00a0<\/p>\n
The research, led by\u00a0Melanie Marsh, M.D., assistant professor at Wake Forest\u00a0University\u00a0School of Medicine\u00a0in North Carolina\u00a0and\u00a0clinician\u00a0at Advocate Children’s Hospital\u00a0in Illinois,\u00a0found that\u00a0the routine step of\u00a0performing\u00a0renal\u00a0and bladder ultrasounds too soon,\u00a0while a child still\u00a0has a fever\u00a0or shortly after fever resolves,\u00a0could lead to “false positives” of\u00a0abnormal findings.\u00a0These early findings could then\u00a0prompt\u00a0additional\u00a0invasive testing that may not be\u00a0necessary,\u00a0along with\u00a0additional\u00a0follow-up appointments,\u00a0adding angst and\u00a0costs\u00a0for the children and their families.\u00a0<\/p>\n
“We’re\u00a0due for updated guidance for physicians surrounding imaging following a UTI diagnosis. In the meantime, we wanted to figure out the best time for a renal\u00a0and\u00a0bladder ultrasound,” Marsh said, adding that the\u00a0recommendation\u00a0from\u00a0the\u00a0American Academy of Pediatrics is to ensure patients ages 2 months to 2 years\u00a0old\u00a0receive an\u00a0ultrasound to check for any\u00a0anatomic abnormalities in the\u00a0kidneys,\u00a0bladder\u00a0or urinary tract.\u00a0<\/p>\n
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It’s common for patients to receive this ultrasound while they’re in the hospital, but we wanted to understand if there’s a difference between getting it the day of diagnosis or closer to discharge.”<\/p>\n
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Melanie Marsh, M.D., Assistant Professor, Wake Forest\u00a0University\u00a0School of Medicine, North Carolina<\/p>\n
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Researchers examined\u00a0medical record\u00a0data\u00a0of\u00a0about 300\u00a0children hospitalized between 2018 and 2022\u00a0at Advocate Children’s Hospital\u00a0in Illinois, Atrium Health’s\u00a0Levine Children’s\u00a0and\u00a0Wake Forest Brenner Children’s\u00a0hospitals in North Carolina,\u00a0Aurora\u00a0Children’s\u00a0Health\u00a0in Wisconsin\u00a0and Nationwide Children’s Hospital in Ohio.\u00a0<\/p>\n
They found that ultrasounds performed within the first 24 hours of a child’s last fever were significantly more likely to show abnormal\u00a0results, many of which\u00a0then resolved and\u00a0were\u00a0likely related\u00a0to the temporary fever.\u00a0<\/p>\n
“Ultrasounds performed later in the hospital stay had less risk of false positives,” Marsh said. “And that means less chance of additional\u00a0and invasive tests.”\u00a0<\/p>\n
If\u00a0an initial\u00a0ultrasound\u00a0indicates\u00a0abnormal results, the next step is\u00a0a voiding\u00a0cystourethrograms (VCUGs), which involve catheterization and radiation exposure.\u00a0<\/p>\n
“Families are already under tremendous stress when their child is hospitalized,” Marsh said. “Our findings suggest that a short delay in imaging may help avoid unnecessary testing while still ensuring children receive safe, appropriate care.”\u00a0<\/p>\n
The results also showed waiting until a fever resolved and closer to hospital discharge did not\u00a0ultimately prolong\u00a0the hospital\u00a0stay.\u00a0<\/p>\n
“This study helps clinicians strike the right balance between avoiding unnecessary procedures and ensuring serious conditions are not missed,” said Marsh. “It gives pediatricians practical, evidence\u2011based guidance they can use in real\u2011world hospital settings.”\u00a0<\/p>\n
The authors note further studies are\u00a0needed,\u00a0but their findings could\u00a0provide\u00a0timely\u00a0guidance\u00a0for pediatricians working in hospitals across the country.\u00a0<\/p>\n
Source:<\/p>\n
Wake Forest University School of Medicine<\/a><\/p>\n Journal reference:<\/p>\n