title: Cost and radiation exposure in the workup of febrile pediatric urinary tract infections.
abstract: Technetium-99m dimercaptosuccinic acid (DMSA) scans are often used in the evaluation of pediatric patients with febrile urinary tract infections (UTIs). Given the prevalence of febrile UTIs, we sought to quantify the cost, radiation exposure, and clinical utility of DMSA scans when compared with dedicated pediatric renal ultrasounds (RUSs).
  
  
  
  An institutional review board approved retrospective study of children under the age of 18 years evaluated at our institution for febrile UTIs between the years 2004-2013 was conducted. The patients had to meet all of the following inclusion criteria: a diagnosis of vesicoureteral reflux, a fever >38°C, a positive urine culture, and evaluation with a DMSA scan and RUS. A chart review was used to construct a cost analysis of technical and professional fees, radiographic results, and radiation dose equivalents.
  
  
  
  Overall, 104 children met the inclusion criteria. A total of 122 RUS and 135 DMSA scans were performed. The technical costs of a DMSA scan incurred a 35% cost premium as compared to an RUS. The average effective radiation dose of a single DMSA scan was 2.84 mSv. New radiographic findings were only identified on 7% of those patients who underwent greater than 1 DMSA scan.
  
  
  
  The utility of the unique information acquired from a DMSA scan as compared to a RUS in the evaluation of febrile UTI must be evaluated on an individual case-by-case basis given the increased direct costs and radiation exposure to the patient.
authors.affiliation: Division of Pediatric Urology, James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Jason E
authors.initials: JE
authors.lastname: Michaud
authors.affiliation: Division of Pediatric Urology, James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Natasha
authors.initials: N
authors.lastname: Gupta
authors.affiliation: Division of Pediatric Urology, James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Baumgartner
authors.affiliation: Division of Pediatric Urology, James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Brian
authors.initials: B
authors.lastname: Kim
authors.affiliation: The Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Thangamadhan
authors.initials: T
authors.lastname: Bosemani
authors.affiliation: Division of Pediatric Urology, James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: mwang33@jhmi.edu.
authors.forename: Ming-Hsien
authors.initials: MH
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data*; D005260:Female; D005334:Fever / Q000209:etiology; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008396:Maryland; D000069079:Radiation Exposure / Q000706:statistics & numerical data*; D011877:Radionuclide Imaging / Q000191:economics; D019275:Radiopharmaceuticals / Q000191:economics; D012189:Retrospective Studies; D019783:Technetium Tc 99m Dimercaptosuccinic Acid / Q000191:economics; D014463:Ultrasonography / Q000191:economics; D014552:Urinary Tract Infections / Q000150:complications / Q000000981:diagnostic imaging* / Q000191:economics*
chemical_list: D019275:Radiopharmaceuticals; D019783:Technetium Tc 99m Dimercaptosuccinic Acid
keywords: Radionuclide imaging; Urinary tract infection; Vesicoureteral reflux