title: Evaluating different imaging strategies in children after first febrile urinary tract infection.
abstract: We conducted a retrospective multicenter review to estimate the prevalence of urological abnormalities in Chinese children with first febrile urinary tract infection (UTI) and to evaluate the selective imaging strategy recommended by the NICE guideline for detecting underlying abnormalities. Atypical UTI was defined as in the NICE UTI guideline. Overall, 576 boys and 244 girls aged below 24 months were reviewed. All underwent ultrasound (US) and micturating cystourethrogram (MCUG) and 612 underwent DMSA scans. US was abnormal in 73 (8.9%) and vesicoureteral reflux was shown in 195 patients (23.8%). A total of 126 patients were considered to have remediable urological abnormalities requiring additional surgical or medical interventions. The NICE guideline yielded excellent negative predictive values (NPV) of 100-94.4% in girls but 91% in boys. If all boys underwent US and DMSA and only those with atypical UTI or abnormal US or DMSA proceeded to MCUG, then the NPV increased to 95.2% and 97.4% for boys aged below and above 6 months, respectively. These revised strategies would substantially save invasive studies-DMSA and MCUG in 27 and 74% of girls aged below and above 6 months, respectively, or MCUG in 23 and 59% of boys aged below and above 6 months, respectively.
authors.affiliation: Department of Paediatrics & Adolescent Medicine, Tuen Mun Hospital, Tsing Chung Koon Road, Tuen Mun, Hong Kong. snwong@hkucc.hku.hk
authors.forename: Sik-Nin
authors.initials: SN
authors.lastname: Wong
authors.forename: Niko Kei-Chiu
authors.initials: NK
authors.lastname: Tse
authors.forename: Kwok-Piu
authors.initials: KP
authors.lastname: Lee
authors.forename: So-Fun
authors.initials: SF
authors.lastname: Yuen
authors.forename: Lettie Chuk-Kwan
authors.initials: LC
authors.lastname: Leung
authors.forename: Benjamin Chee-Kit
authors.initials: BC
authors.lastname: Pau
authors.forename: Winnie Kwai-Yu
authors.initials: WK
authors.lastname: Chan
authors.forename: Kwok-Wai
authors.initials: KW
authors.lastname: Lee
authors.forename: Hon-Ming
authors.initials: HM
authors.lastname: Cheung
authors.forename: Stella
authors.initials: S
authors.lastname: Chim
authors.forename: Cynthia Mung-Sze
authors.initials: CM
authors.lastname: Yip
mesh_terms: D044466:Asian People; D002648:Child; D003952:Diagnostic Imaging / Q000379:methods*; D005260:Female; D005334:Fever; D006801:Humans; D007223:Infant; D008297:Male; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D004113:Succimer; D014552:Urinary Tract Infections / Q000175:diagnosis*
chemical_list: D019275:Radiopharmaceuticals; D004113:Succimer