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Algorithms imaging tests comparison following the first febrile urinary tract infection in children
María M Tombesi1, Laura F Alconcher2, Lucas Lucarelli2
1Servicio de Medicina por Imágenes, Hospital Interzonal Dr. José Penna, Bahía Blanca, Argentina. mariamarcelatombesi8@gmail.com.
Insights
Comparing pediatric urinary tract infection (UTI) imaging guidelines reveals intensive protocols are sensitive but costly. Less intensive British and American guidelines miss more cases but significantly reduce radiation exposure and expenses.
Area of Science:
- Pediatric Nephrology and Urology
- Diagnostic Imaging
- Healthcare Economics
Background:
- First febrile urinary tract infection (UTI) in children requires accurate diagnosis to prevent complications like vesicoureteral reflux (VUR) and renal scarring.
- Established imaging algorithms, including those from the Argentine Society of Pediatrics (2003 and 2015), British, and American guidelines, aim to balance diagnostic sensitivity with radiation exposure and cost.
Purpose of the Study:
- To compare the diagnostic sensitivity, associated costs, and radiation doses of imaging algorithms for children after their first febrile UTI.
- To evaluate the 2003 and 2015 Argentine Society of Pediatrics algorithms against current British and American guidelines.
Main Methods:
- Retrospective simulation comparing diagnostic algorithms.
- Inclusion criteria: Children aged ≤ 2 years with their first febrile UTI, normal initial ultrasound, voiding cystourethrography, and dimercaptosuccinic acid scintigraphy per the 2003 Argentine algorithm.
- Analysis focused on diagnostic yield for VUR and renal scarring, cost, and radiation dose.
Main Results:
- Eighty patients were analyzed; 63% had VUR, and 7.5% had renal scarring.
- The 2015 Argentine algorithm would have missed 4 VUR cases and 2 renal scarring cases, incurring lower costs (ARS 301,800) and radiation (124 mSv) compared to the 2003 algorithm (ARS 404,000, 160 mSv).
- British and American guidelines would have missed all VUR and renal scarring cases, but at significantly lower costs (ARS 23,000 and ARS 40,000, respectively) and with zero radiation.
Conclusions:
- Intensive diagnostic protocols demonstrate high sensitivity for detecting VUR and renal scarring.
- However, these intensive approaches are associated with substantial costs and radiation doses.
- The clinical benefits of intensive protocols may be questionable when weighed against their financial and radiation burdens.
Objetives:
To compare the diagnostic sensitivity, costs and radiation doses of imaging tests algorithms developed by the Argentine Society of Pediatrics in 2003 and 2015, against British and American guidelines after the first febrile urinary tract infection (UTI).
Population And Methods:
Inclusion criteria: children ≤ 2 years old with their first febrile UTI and normal ultrasound, voiding cystourethrography and dimercaptosuccinic acid scintigraphy, according to the algorithm established by the Argentine Society of Pediatrics in 2003, treated between 2003 and 2010. The comparisons between algorithms were carried out through retrospective simulation.
Results:
Eighty (80) patients met the inclusion criteria; 51 (63%) had vesicoureteral reflux (VUR); 6% of the cases were severe. Renal scarring was observed in 6 patients (7.5%). Cost: ARS 404,000. Radiation: 160 millisieverts. With the Argentine Society of Pediatrics' algorithm developed in 2015, the diagnosis of 4 VURs and 2 cases of renal scarring would have been missed. The cost of this omission would have been ARS 301,800 and 124 millisieverts of radiation. British and American guidelines would have missed the diagnosis of all VURs and all cases of renal scarring, with a related cost of ARS 23,000 and ARS 40,000, respectively and 0 radiation.
Conclusion:
Intensive protocols are highly sensitive to VUR and renal scarring, but they imply high costs and doses of radiation, and result in questionable benefits.
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