THE APPROPRIATENESS OF USE AND THE CLINICAL IMPACT OF MICTURATING CYSTOURETHROGRAPHY IN PEDIATRIC PRACTICE

Study objective: To determine the appropriateness of use and the clini cal impact of micturating cystourethrography (MCU) in paediatric pract ice. Design: Retrospective medical record review. Setting: A major tea ching children's hospital in the Trent region. Patients: Consecutive s ample of 120 children undergoing MCU during 1991-1992, identified from the radiology records. Main outcome measures: The referring clinician 's reasons for requesting an MCU; the clinical management plan pursued before and after the MCU, and the change in management initiated by t he result of the examination; the appropriateness of use of the test, as determined by the presence or absence of a valid indication for MCU in the specific clinical situation. Results: The change in patient ma nagement attributable to the MCU result could be categorized as: no ch ange (19%); decision to end the imaging investigation of the patient ( 33%); decision to end all investigations, and prophylactic or therapeu tic interventions (16%); decision to discontinue chemoprophylaxis (2%) ; decision to end the imaging investigation and introduce chemoprophyl axis and follow-up for bacteriuria (6%); decision to continue the imag ing investigation and introduce chemoprophylaxis and follow-up for bac teriuria (13%); and decision to operate or help in planning the surgic al treatment required (11%). Inappropriate use of the test was observe d in 20% of the cases. Conclusions: This study provides a basis for un derstanding the use of MCU in paediatric practice. The findings that 1 9% of the cystourethrograms had no appreciable effect, and that 20% of the examinations were used inappropriately show the need for increase d effort to minimize overuse of the test.