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Different guidelines for imaging after first UTI in febrile infants: yield, cost, and radiation

Claudio La Scola1, Chiara De Mutiis, Ian K Hewitt

  • 1Nephrology, Dialysis Unit, Department of Pediatrics, Azienda Ospedaliero Universitaria Sant'Orsola-Malpighi Bologna, Bologna, Italy.

Pediatrics
|February 27, 2013
PubMed

Insights

No single diagnostic protocol is ideal for children after their first febrile urinary tract infection. Aggressive approaches detect more vesicoureteral reflux and scarring but increase costs and radiation exposure.

Area of Science:

  • Pediatric Nephrology
  • Diagnostic Imaging
  • Health Economics

Background:

  • Febrile urinary tract infections (UTIs) in children can lead to renal scarring and vesicoureteral reflux (VUR).
  • Diagnostic algorithms aim to identify these complications efficiently, balancing yield with cost and radiation exposure.

Purpose of the Study:

  • To compare the diagnostic yield, economic costs, and radiation exposure of five different diagnostic algorithms versus a comprehensive testing protocol for children following their first febrile UTI.

Main Methods:

  • Retrospective analysis of 304 children (2-36 months) from a randomized controlled trial.
  • Simulated application of five guideline-based diagnostic protocols: 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: diagnostic yield for VUR and renal scarring. Secondary outcomes: economic and radiation costs.

Main Results:

  • Vesicoureteral reflux (VUR) identified in 22% and scarring in 15% of children.
  • The 'top down' approach had the highest sensitivity for VUR (76%) and scarring (100%) but also the highest costs (€52,268) and radiation (624 mSv).
  • NICE and AAP protocols showed high specificity for VUR (90%), with NICE being least costly (€26,838) and AAP having lowest radiation (42 mSv).

Conclusions:

  • No single diagnostic protocol is optimal for evaluating children after a first febrile UTI.
  • Aggressive protocols offer high sensitivity for detecting VUR and scarring but incur significant financial and radiation burdens.
  • The choice of protocol involves a trade-off between diagnostic sensitivity, specificity, cost, and radiation exposure.
Abstract

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