693 - Determining the completion rate of outpatient renal and bladder ultrasound in young children following emergency department diagnosis of first febrile urinary tract infection

Publication Number: 3670.693

Erica Potts, Dayton Children's Hospital, OAKWOOD, OH, United States; Shernaz A. Wadia, Dayton Children's Hospital, Mason, OH, United States

Background: Urinary Tract Infection (UTI) is a common diagnosis in young children in the emergency department. The American Academy of Pediatrics (AAP) recommends that all children from 2 months to 2 years old who are diagnosed with a first febrile UTI should undergo renal and bladder ultrasound (RBUS) following resolution of acute infection to evaluate for anatomic abnormalities or vesicoureteral reflux that could predispose them to recurrent UTIs.

Objective: We sought to evaluate the compliance with the AAP recommendations for RBUS for children diagnosed with a first febrile UIT at a tertiary care children’s hospital emergency department.

Design/Methods: Children aged 2-24 months who were seen in the emergency department at an urban freestanding children’s hospital between July 2020 and December 2023 with a first febrile UTI were included. The primary outcome was the completion of RBUS performed following diagnosis. Descriptive statistics and logistic regression were used to determine the effect of demographic and laboratory factors on the primary outcome.

Results: 258 children were included. 93% (n = 240) were female and average age was 10.16 (SD = 5.97) months. RBUS was performed in 41.5% (n = 107) of participants. 84% (n = 90) of children with RBUS performed had imaging done within 3 months of initial diagnosis. Black children had 75.3% lower odds of obtaining an ultrasound compared to white children (OR 0.247, 95% CI [0.104, 0.538]). Patients without a PCP had 61.9% lower odds of obtaining an ultrasound (OR 0.381, 95% CI [0.176, 0.781]). Distance from the hospital and median household income were not found to be statistically significant predictors of obtaining RBUS.

Conclusion(s): Overall, less than half of the patients in our study had RBUS performed in compliance with the AAP guidelines. Black children and those without a PCP had significantly lower odds of obtaining an ultrasound. Future studies should focus on interventions to help all patient receive the standard of care, including the possibility of obtaining RBUS at the time of diagnosis in the emergency department.

Participant Characteristics
UTI-table-1.jpegParticipant characteristics by completion of renal and bladder ultrasound after diagnosis of UTI in the emergency department

Multivariate Logistic Regression Results
UTIregsig.jpegOdds of obtaining renal and bladder ultrasound following diagnosis of UTI in the emergency department