Is Top-down vs Bottom-up Radiological Evaluation after Febrile Urinary Tract Infection Really Less Stressful for the Child and Family? Challenging the Dogma

Abstract

Although the top-down approach and repeat voiding cystourethrography cause less anxiety for caregivers, these values do not correlate to pain scale in children. This finding might be due to lack of appropriate evaluation tools of pediatric pain and anxiety. However, the theory that the top-down approach is less invasive, and thus less stressful, requires further research. The Child-Adult Medical Procedure Interaction Scale-Revised data indicate that influences in adult-child interaction are bidirectional.

Pain and distress outcomes in infants and children: a systematic review

“…These results indicate that the studies reviewed herein had high methodological quality. The nine observational studies evaluated according to the STROBE statement also demonstrated good methodological quality; 4 conformed with 60-70% of the items (46,47,48,50), 4 conformed with 70-80% of the items (42–45), and 1 conformed with >90% of the items (49). …”

“…The other seven articles were published in different countries. With regard to the methodological designs of the studies, 14 (61%) of the articles were RCTs (27–40), 7 (30%) used a cross-sectional design (41–47) and 2 (9%) used a cohort design (48,49). …”

“…Fourteen studies (61%) included children of preschool and school age (3-12 years old) (28–30,32,34,36,38,40,41,43,44,47,48,50), and 9 (39%) included infants (0-2 years old) (31,33,35,37,39,42,45,46,49). The majority of the studies assessed acute pain during medical procedures (n=20, 87%).…”

“…Table 5 presents the characteristics and findings of five observational studies in children. Three studies assessed acute pain conditions (44,47,50), two of which evaluated needle procedures (44,50). McCarthy et al (44) examined children’s pain and distress (measured by combined tools) during an intravenous insertion procedure with parental distraction coaching.…”

This Month in Pediatric Urology

“…In a prospective study Telli et al (page 958) from Turkey evaluated vesicoureteral reflux after febrile urinary tract infection using the top-down approach of dimercaptosuccinic acid scan vs the bottom-up approach of voiding cystourethrography (VCUG). 4 They also compared an additional group of children undergoing repeat VCUG to assess whether vesicoureteral reflux had improved. Children were randomly assigned to the top-down or the bottom-up approach.…”