Evaluating different imaging strategies in children after first febrile urinary tract infection

We conducted a retrospective multicenter review to estimate the prevalence of urological abnormalities in Chinese children with first febrile urinary tract infection (UTI) and to evaluate the selective imaging strategy recommended by the NICE guideline for detecting underlying abnormalities. Atypica...

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Bibliographic Details
Published in:Pediatric nephrology (Berlin, West) West), 2010-10, Vol.25 (10), p.2083-2091
Main Authors: Wong, Sik-Nin, Tse, Niko Kei-Chiu, Lee, Kwok-Piu, Yuen, So-Fun, Leung, Lettie Chuk-Kwan, Pau, Benjamin Chee-Kit, Chan, Winnie Kwai-Yu, Lee, Kwok-Wai, Cheung, Hon-Ming, Chim, Stella, Yip, Cynthia Mung-Sze
Format: Article
Language:English
Subjects:
Antibiotics
Asian Continental Ancestry Group
Child
Children
Children & youth
Diagnostic Imaging - methods
Female
Fever
Health aspects
Hospitals
Humans
Infant
Leukocytes
Male
Medicine
Medicine & Public Health
Microscopy
Nephrology
Original Article
Patients
Pediatrics
Practice Guidelines as Topic
Predictive Value of Tests
Radiopharmaceuticals
Retrospective Studies
Succimer
Ultrasonic imaging
Urinalysis
Urinary tract diseases
Urinary tract infections
Urinary Tract Infections - diagnosis
Urine
Urogenital system
Urology
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Summary:We conducted a retrospective multicenter review to estimate the prevalence of urological abnormalities in Chinese children with first febrile urinary tract infection (UTI) and to evaluate the selective imaging strategy recommended by the NICE guideline for detecting underlying abnormalities. Atypical UTI was defined as in the NICE UTI guideline. Overall, 576 boys and 244 girls aged below 24 months were reviewed. All underwent ultrasound (US) and micturating cystourethrogram (MCUG) and 612 underwent DMSA scans. US was abnormal in 73 (8.9%) and vesicoureteral reflux was shown in 195 patients (23.8%). A total of 126 patients were considered to have remediable urological abnormalities requiring additional surgical or medical interventions. The NICE guideline yielded excellent negative predictive values (NPV) of 100–94.4% in girls but 91% in boys. If all boys underwent US and DMSA and only those with atypical UTI or abnormal US or DMSA proceeded to MCUG, then the NPV increased to 95.2% and 97.4% for boys aged below and above 6 months, respectively. These revised strategies would substantially save invasive studies—DMSA and MCUG in 27 and 74% of girls aged below and above 6 months, respectively, or MCUG in 23 and 59% of boys aged below and above 6 months, respectively.
ISSN:0931-041X
1432-198X
DOI:10.1007/s00467-010-1569-z