OBJECTIVE: To evaluate the yield, economic, and radiation costs of 5 diagnostic algorithms compared with a protocol where all tests are performed (ultrasonography scan, cystography, and late technetium99dimercaptosuccinic acid scan) in children after the first febrile urinary tract infections. METHODS: A total of 304 children, 2 to 36 months of age, who completed the diagnostic follow-up (ultrasonography, cystourethrography, and acute and late technetium99dimercaptosuccinic acid scans) of a randomized controlled trial (Italian Renal Infection Study 1) were eligible. The guidelines applied to this cohort in a retrospective simulation were: Melbourne Royal Children’s Hospital, National Institute of Clinical Excellence (NICE), top down approach, American Academy of Pediatrics (AAP), and Italian Society of Pediatric Nephrology. Primary outcomes were the yield of abnormal tests for each diagnostic protocol; secondary outcomes were the economic and radiation costs. RESULTS: Vesicoureteral reflux (VUR) was identified in 66 (22%) children and a parenchymal scarring was identified in 45 (15%). For detection of VUR (47/66) and scarring (45/45), the top down approach showed the highest sensitivity (76% and 100%, respectively) but also the highest economic and radiation costs (€52 268. 624 mSv). NICE (19/66) and AAP (18/66) had the highest specificities for VUR (90%) and the Italian Society of Pediatric Nephrology had the highest specificity (20/45) for scars (86%). NICE would have been the least costly (€26 838) and AAP would have resulted in the least radiation exposure (42 mSv). CONCLUSIONS: There is no ideal diagnostic protocol following a first febrile urinary tract infection. An aggressive protocol has a high sensitivity for detecting VUR and scarring but carries high financial and radiation costs with questionable benefit.
Different guidelines for imaging after first UTI in febrile infants : yield, cost, and radiation / C. La Scola, C. De Mutiis, I. Hewitt, G. Puccio, A. Toffolo, P. Zucchetta, F. Mencarelli, M. Marsciani, R. Dall'Amico, G. Montini. - In: PEDIATRICS. - ISSN 0031-4005. - 131:3(2013 Mar), pp. e665-e671.
|Titolo:||Different guidelines for imaging after first UTI in febrile infants : yield, cost, and radiation|
MONTINI, GIOVANNI (Ultimo)
|Parole Chiave:||urinary tract infection guidelines; vesicoureteral reflux; voiding cystourethrography; renal DMSA scan|
|Settore Scientifico Disciplinare:||Settore MED/38 - Pediatria Generale e Specialistica|
|Data di pubblicazione:||mar-2013|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1542/peds.2012-0164|
|Appare nelle tipologie:||01 - Articolo su periodico|