Timing is critical when using ultrasound for pediatric UTI cases
New data could alter how providers treat and manage the cases of infants and young children who are hospitalized with urinary tract infections (UTIs).
Febrile UTIs are among the most common infections in early childhood. Though these infections are typically routinely treatable, providers take extra caution to ensure appropriate care for pediatric cases, as children are more vulnerable to negative side effects. Many providers turn to ultrasound of the bladder and/or kidneys to determine the exact cause of the infection, but this latest research suggests that imaging may not be warranted in many cases.
According to the new findings from the Advocate Aurora Research Institute , ultrasound shortly after a child’s fever resolves could result in more false positives, which in turn may lead to additional unnecessary and sometimes invasive testing.
“It’s common for patients to receive this ultrasound while they’re in the hospital, but we wanted to understand if there’s a difference between getting it the day of diagnosis or closer to discharge,” notes Melanie Marsh, MD, an assistant professor at the Wake Forest University School of Medicine in North Carolina and a clinician at Advocate Children’s Hospital in Park Ridge, Illinois.
Current recommendations from the American Academy of Pediatrics suggest that children ages 2 months to 2 years get an ultrasound in UTI cases to rule out any anatomical abnormalities. But when these scans should take place has been largely up for debate. To get a better feel for the ideal imaging window, Marsh and colleagues retrospectively analyzed the cases of 300 children who had been hospitalized with UTI between 2018 and 2022. The team compared how long after diagnosis the exams took place, ultrasound findings and other medical data to determine whether specific factors were associated with positive results.
The group observed associations between abnormal findings and ultrasounds that were conducted within 24 hours of a child’s last fever. When exams were completed during this window, they often produced abnormal findings that resolved once their fever went away. Specifically, uroepithelial thickening was a more common finding among early ultrasounds compared to those conducted more than 24 hours after fever resolution.
These findings led to voiding cystourethrograms, over half of which were deemed normal, significantly more often in the early group than the late one.
“Ultrasounds performed later in the hospital stay had less risk of false positives. And that means less chance of additional and invasive tests,” Marsh notes. “This study helps clinicians strike the right balance between avoiding unnecessary procedures and ensuring serious conditions are not missed. It gives pediatricians practical, evidence‑based guidance they can use in real‑world hospital settings.”
Read more from the study here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.