Practice guidelines for imaging studies in children after the first urinary tract infection.
OBJECTIVE
Urinary tract infection is common in children and may be associated with significant urinary tract pathology. Many children are investigated for vesicoureteral reflux after the first urinary tract infection but less than a quarter have reflux. Imaging with voiding cystourethrogram is not without risk. An approach was proposed to predict reflux in children with a urinary tract infection. We sought to validate a preestablished clinical decision rule to target voiding cystourethrogram more efficiently in children after the first urinary tract infection.


METHODS
We tested the usefulness of a clinical decision rule to predict vesicoureteral reflux in 406 consecutive children younger than 5 years who were treated or referred for consultation due to an acute urinary tract infection. Symptoms and signs of urinary tract infection and imaging findings were analyzed.


RESULTS
Vesicoureteral reflux was found in 120 children (35%), including 69 (20%) with grade III-V reflux. An abnormal ultrasound finding was seen in 71 cases (18%) but was not associated with reflux. The clinical decision rule appeared to have poor sensitivity of only 24% to identify grade III-V reflux. We found it impractical to predict vesicoureteral reflux in children with a urinary tract infection.


CONCLUSIONS
Results show that it is not possible to predict grade III-V vesicoureteral reflux reliably using the clinical decision rule. The recent guidelines recommending a search for reflux after a urinary tract infection in children cannot be revised using this decision rule.
Venhola
Mika
M
Departments of Paediatrics, Oulu University Hospital, Oulu and Central Hospital of Central Finland, Jyväskylä, Finland. mika.venhola@ppshp.fi
Huttunen
Niilo-Pekka
NP
Renko
Marjo
M
Pokka
Tytti
T
Uhari
Matti
M
D002675:Child, Preschool; D003661:Decision Support Techniques; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014552:Urinary Tract Infections / Q000175:diagnosis*; D014718:Vesico-Ureteral Reflux / Q000175:diagnosis*