This article is more than 5 years old. Information may no longer be current.
No ideal diagnostic protocol for first febrile UTI
Click Here to Manage Email Alerts
Current modalities to evaluate first febrile urinary tract infections vary in sensitivity and specificity, and aggressive protocols may not be worth the financial and radiological costs, according to study results published online.
Claudio La Scola, MD, and colleagues of the nephrology and dialysis unit at the department of pediatrics, Azienda Ospedaliero-Universitaria Sant’Orsola-Malpigh in Bologna, Italy, evaluated five diagnostic algorithms: Melbourne Royal Children’s Hospital; National Institute of Clinical Excellence (NICE); top-down approach; AAP; and Italian Society of Pediatric Nephrology. The researchers compared these algorithms against reference standards such as ultrasonography scan, cystography and late technetium-99m dimercaptosuccinic acid scan.
La Scola and colleagues assessed the yield of abnormal tests, as well as the financial and radiation costs in 304 children aged 2 to 36 months after a first febrile UTI.
The researchers reported that vesicoureteral reflux (VUR) was present in 66 children, and parenchymal scarring was present in 45 children.
The top-down approach showed the highest sensitivity in detecting VUR and scarring (76% and 100%, respectively) but also was the most expensive at nearly €52,270 ($70,000 US). It also had the highest radiation cost (624 mSv). Researchers also reported that 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%). The least expensive was NICE at nearly €26,840 ($36,960), and AAP led to the least exposure to radiation (42 mSv).
Researchers concluded that although there is no ideal diagnostic protocol, this study “may be useful in helping the practicing clinician decide which algorithm is most applicable for any given patient and family, considering multiple variables: socioeconomic, cultural, and geographical.”
Disclosure: La Scola reports no relevant financial disclosures.
Click Here to Manage Email Alerts