How Do the Revised Guidelines on Management of Urinary Tract Infection in Young Children Work in the Local Population

The purpose of follow up imaging study after first febrile urinary tract infection (UTI) is to detect urological abnormalities that need timely diagnosis and treatment. Recent guidelines attempt to recommend imaging in high risk children while avoiding unnecessary investigation in children who do not need them. This study retrospectively surveyed a local cohort of 820 children who had first febrile UTI when aged below 24 months and who had underwent full imaging studies. Significant urological abnormalities were found in 58 patients (7.1%), including 9 requiring surgical treatment, 37 with grade IV-V vesicoureteral reflux (VUR) and 12 with severe renal scarring. Four imaging strategies were tested in terms of number of imaging needed and the risk of missing the 58 target patients: The first strategy (ultrasonography (USG) for all patients and voiding cystourethrogram (VCUG) for those with abnormal USG or UTI recurrence) would need VCUG in 87 patients and missed 24% of the target patients (1.7% of whole cohort). The second strategy (USG for all patients and VCUG for those with clinical risk factors or USG