ROUTINE DIAGNOSTIC-IMAGING FOR CHILDHOOD URINARY-TRACT INFECTIONS - ASYSTEMATIC OVERVIEW

Objective: To assess the quality of the evidence on which current reco mmendations for routine diagnostic imaging for childhood urinary tract infection are based. Methods: A systematic overview of the literature using the MEDLINE database (1966 to October 1994), article bibliograp hies, and a manual search of current publications using Current Conten ts, was undertaken, Preset criteria were used to categorize study samp le and design, and interrater reliability was assessed with a random s ample. Results: A total of 434 publications were evaluated, and 63 stu dies met the criteria for inclusion, There was 100% interrater agreeme nt on inclusion eligibility and design classification, No controlled t rials or analytic studies evaluating routine diagnostic imaging were f ound, All 63 studies were descriptive, and only 10 were prospective, N one of the studies provided evidence of the impact of routine imaging on the development of renal scars and clinical outcomes in children wi th their first urinary tract infection. Conclusion: Methodologically s ound, prospective studies are needed to assess whether children with t heir first urinary tract infection who have routine diagnostic imaging are better off than children who have imaging for specific indication s. We conclude that the current recommendations are not based on firm evidence.