Dick P T, Feldman W
Paediatric Outcomes Research Team, Hospital for Sick Children, Toronto, Ontario, Canada.
J Pediatr. 1996 Jan;128(1):15-22. doi: 10.1016/s0022-3476(96)70422-5.
To assess the quality of the evidence on which current recommendations for routine diagnostic imaging for childhood urinary tract infection are based.
A systematic overview of the literature using the MEDLINE database (1966 to October 1994), article bibliographies, and a manual search of current publications using Current Contents, was undertaken. Preset criteria were used to categorize study sample and design, and interrater reliability was assessed with a random sample.
A total of 434 publications were evaluated, and 63 studies met the criteria for inclusion. There was 100% interrater agreement on inclusion eligibility and design classification. No controlled trials or analytic studies evaluating routine diagnostic imaging were found. All 63 studies were descriptive, and only 10 were prospective. None of the studies provided evidence of the impact of routine imaging on the development of renal scars and clinical outcomes in children with their first urinary tract infection.
Methodologically sound, prospective studies are needed to assess whether children with their first urinary tract infection who have routine diagnostic imaging are better off than children who have imaging for specific indications. We conclude that the current recommendations are not based on firm evidence.
评估当前关于儿童尿路感染常规诊断性影像学检查建议所依据的证据质量。
利用MEDLINE数据库（1966年至1994年10月）、文章参考文献，并使用《现刊目次》对手头搜索当前出版物进行文献系统综述。采用预设标准对研究样本和设计进行分类，并用随机样本评估评分者间信度。
共评估了434篇出版物，63项研究符合纳入标准。在纳入资格和设计分类方面评分者间一致性达100%。未发现评估常规诊断性影像学检查的对照试验或分析性研究。所有63项研究均为描述性研究，仅10项为前瞻性研究。没有一项研究提供证据表明常规影像学检查对首次尿路感染儿童的肾瘢痕形成及临床结局有影响。
需要进行方法学上合理的前瞻性研究，以评估首次尿路感染时接受常规诊断性影像学检查的儿童是否比因特定指征接受影像学检查的儿童情况更好。我们得出结论，当前的建议并非基于确凿证据。
