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

Area of Science:

• Pediatric Urology
• Diagnostic Imaging
• Infectious Diseases

Background:

• Febrile urinary tract infection (UTI) in children can indicate underlying urological abnormalities.
• Current guidelines, such as the NICE guideline, recommend selective imaging to identify these issues.
• The prevalence and optimal diagnostic approach for pediatric UTI require further investigation.

Purpose of the Study:

• To estimate the prevalence of urological abnormalities in Chinese children experiencing their first febrile UTI.
• To evaluate the effectiveness of the NICE guideline's selective imaging strategy in detecting these abnormalities.
• To propose optimized imaging strategies for improved diagnostic yield and reduced invasive procedures.

Main Methods:

• A retrospective multicenter review of 576 boys and 244 girls under 24 months with first febrile UTI.
• All patients underwent ultrasound (US) and micturating cystourethrogram (MCUG); 612 had DMSA scans.
• Analysis of diagnostic accuracy, including negative predictive values (NPV), for the NICE guideline and revised strategies.

Main Results:

• Urological abnormalities were found in 126 patients (16.3%).
• The NICE guideline showed high NPV (94.4-100%) in girls but lower (91%) in boys.
• A revised strategy involving US and DMSA before MCUG improved NPV in boys and significantly reduced the need for invasive studies in both sexes.

Conclusions:

• The NICE guideline is a useful tool but may miss abnormalities in boys.
• Revised imaging protocols, incorporating US and DMSA selectively, can enhance diagnostic accuracy and reduce invasive testing in pediatric UTI.
• Optimized strategies are crucial for efficient management of urological abnormalities in children.