No stand-out among pediatric UTI diagnostic algorithms

From Pediatric News, 6 March 2013:

There is no one perfect diagnostic algorithm for children with a first uncomplicated febrile urinary tract infection, according to a retrospective cohort simulation comparing six diagnostic approaches for yield, cost, and radiation dose.

Five diagnostic algorithms possibly using ultrasound, voiding cystourethrography (VCUG), and late technetium99 dimercaptosuccinic acid (DMSA) scan renal scintigraphy, plus an “all tests performed” protocol were retrospectively simulated using data from 304 children aged 2-36 months with a first uncomplicated febrile UTI who had participated in an earlier multicenter trial.

While the National Institute of Clinical Excellence (NICE 2007) and American Academy of Pediatrics (AAP 2011) algorithms had the highest specificities for vesicoureteral reflux (91% and 90% respectively), the Italian Society of Pediatric Nephrology (ISPN 2011) had the highest specificity for scars (86%), according to Dr. Claudio La Scola and colleagues. The report was published online in the Feb. 25 issue of Pediatrics (2013;131:e665–71 [doi:10.1542/peds.2012-0164]).

The “top down approach” (TDA 2007) had the highest sensitivity for detecting vesicoureteral reflux (VUR) (76%) and scarring (100%), but also was the most costly financially (52,268 euros) and in radiation dose (624 mSv). The study also evaluated the Royal Children’s Hospital of Melbourne algorithm (RCH 2006).

“An aggressive protocol has a high sensitivity for detecting abnormalities, which in some cases could be of questionable benefit to the infants, and it is burdened with high financial and radiation costs,” wrote Dr. La Scola of Azienda Ospedaliero-Universitaria, Bologna, Italy, and his coauthors. Read more.

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