The appropriateness of use and the clinical impact of micturating cystourethrography in paediatric practice

• Published in: Clinical radiology Vol. 49; no. 8; pp. 541 - 545
• Main Authors: Mussurakis, S., Sprigg, A., Steiner, G.M.
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Ltd 01.08.1994; Elsevier
• Subjects: Biological and medical sciences; Child; Child Health Services - statistics & numerical data; Child, Preschool; Decision Making; Female; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Patient Care Planning; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Retrospective Studies; Urethra - diagnostic imaging; Urinary Bladder - diagnostic imaging; Urinary system; Urinary Tract Infections - diagnostic imaging; Urination; Urography - statistics & numerical data; Human; Pediatrics; Radiodiagnosis; Micturition; Exploration; Child; Cystourethrography
• ISSN: 0009-9260; 1365-229X
• DOI: 10.1016/S0009-9260(05)82933-2

Study objective: To determine the appropriateness of use and the clinical impact of micturating cystourethrography (MCU) in paediatric practice. Design: Retrospective medical record review. Setting: A major teaching children's hospital in the Trent region. Patients: Consecutive sample 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 the 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 management attributable to the MCU result could be categorized as: no change (19%); decision to end the imaging investigation of the patient (33%); decision to end all investigations, and prophylactic or therapeutic interventions (16%); decision to discontinue chemophrophylaxis (2%); decision to end the imaging investigation and introduce chemoprophylaxis and follow-up for bacteriuria (6%); decision to continue the imaging investigation and introduce chemoprophylaxis and follow-up for bacteriuria (13%); and decision to operate or help in planning the surgical treatment required (11%). Inappropriate use of the test was observed in 20% of the cases. Conclusions: This study provides a basis for understanding the use of MCU in paediatric practice. The findings that 19% of the cystourethrograms had no appreciable effect, and that 20% of the examinations were used inappropriately show the need for increased effort to minimize overuse of the test.