Ordering of renal tract imaging by paediatricians after urinary tract infection (UTI) in children

Williams GJ*1, Sureshkumar P1, Chan SF2, Macaskill P2, Craig JC1,2
1. The Centre for Kidney Research, The Children’s Hospital at Westmead
2. Dept Public Health and Community Medicine, University of Sydney

Aims: To describe and analyse the reported ordering practices of paediatricians for renal tract imaging of children following UTI.

Method: A piloted self administered survey of a random sample of 354 general paediatricians in Australia. The survey included 12 clinical scenarios varying with age, gender and fever. Respondents indicated their probability of ordering a renal ultrasound, micturating cystourethrogram (MCU) and dimercaptosuccinic acid scan (DMSA) from 0 to 100%. A sensitivity analysis was done using a threshold of > 50% to dichotomise paediatrician responses into order or not order each test. Medians and the range of likelihoods were compared across scenarios.

Results: Response rate was 74.6% (264/354). Across all scenarios of age, gender and presence of fever, the median probability of ordering an ultrasound was 100%. For children aged 2 months, likelihood of ordering an MCU was 100%, with little variability, but was 70% for 3 year olds with fever (45% without fever), and about 5% for 6 year olds (irrespective of fever). Median likelihood of ordering a DMSA was 80% at 2 months, 60% at 3 years and 20% at 6 years (40%, 15%, 5% without fever, respectively). Interquartile ranges were very wide for all DMSA probabilities. Analysing the data using dichotomised responses did not alter study results. Child gender did not influence ordering practices

Conclusions: Renal tract imaging practice across paediatricians shows consistent, almost 100% use of the least invasive modality, ultrasound, but considerable variation in the reported ordering of the more invasive tests MCU and DMSA. Doctors order these tests more in younger children and when fever is present.

Presented at the Royal Australasian College of Physicians Congress [RACP]. Cairns, Queensland, Australia 7-11 May 2006

Correspondence
Gabrielle Williams
Centre for Kidney Research
The Children’s Hospital at Westmead
Locked Bag 4001
Westmead NSW 2145 Sydney Australia
Tel: +61 2 9845 3041
Fax: +6 12 9845 3038
Email:Gabrielle Williams