White Rose University Consortium logo
University of Leeds logo University of Sheffield logo York University logo

Further investigation of confirmed urinary tract infection (UTI) in children under five years: a systematic review.

Westwood, M.E., Whiting, P.F., Cooper, J., Watt, I.S. and Kleijnen, J. (2005) Further investigation of confirmed urinary tract infection (UTI) in children under five years: a systematic review. BMC Pediatrics. p. 2. ISSN 1471-2431

Full text available as:
[img]
Preview
Text (bmc_1471-2431-5-2.pdf)
bmc_1471-2431-5-2.pdf

Download (403Kb)

Abstract

Background: Further investigation of confirmed UTI in children aims to prevent renal scarring and future complications. Methods: We conducted a systematic review to determine the most effective approach to the further investigation of confirmed urinary tract infection (UTI) in children under five years of age. Results: 73 studies were included. Many studies had methodological limitations or were poorly reported. Effectiveness of further investigations: One study found that routine imaging did not lead to a reduction in recurrent UTIs or renal scarring. Diagnostic accuracy: The studies do not support the use of less invasive tests such as ultrasound as an alternative to renal scintigraphy, either to rule out infection of the upper urinary tract (LR- = 0.57, 95%CI: 0.47, 0.68) and thus to exclude patients from further investigation or to detect renal scarring (LR+ = 3.5, 95% CI: 2.5, 4.8). None of the tests investigated can accurately predict the development of renal scarring. The available evidence supports the consideration of contrast-enhanced ultrasound techniques for detecting vesico-ureteric reflux (VUR), as an alternative to micturating cystourethrography (MCUG) (LR+ = 14.1, 95% CI: 9.5, 20.8; LR- = 0.20, 95%CI: 0.13, 0.29); these techniques have the advantage of not requiring exposure to ionising radiation. Conclusion: There is no evidence to support the clinical effectiveness of routine investigation of children with confirmed UTI. Primary research on the effectiveness, in terms of improved patient outcome, of testing at all stages in the investigation of confirmed urinary tract infection is urgently required.

Item Type: Article
Copyright, Publisher and Additional Information: © 2005 Westwood et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Academic Units: The University of York > Centre for Reviews and Dissemination (York)
Depositing User: Repository Officer
Date Deposited: 17 Feb 2006
Last Modified: 17 Oct 2013 14:23
Published Version: http://dx.doi.org/10.1186/1471-2431-5-2
Status: Published
Refereed: Yes
Related URLs:
URI: http://eprints.whiterose.ac.uk/id/eprint/1030

Actions (repository staff only: login required)