Paediatric Nephrology Unit, Great North Children's Hospital, , Newcastle, UK.
Arch Dis Child. 2014 May;99(5):448-51. doi: 10.1136/archdischild-2013-304429. Epub 2014 Jan 16.
To compare the childhood urinary tract infection (UTI) guidelines from the Royal College of Physicians (RCP) in 1991 and from National Institute of Health and Care Excellence (NICE) (CG54) in 2007 by measuring their efficiency at detecting urinary tract abnormalities.
Children with UTIs within the Newcastle Primary Care Trust (population 70,800 children) were referred and imaged according to the RCP guidelines during 2008, and these were compared to the activity that would have been undertaken if we had implemented the CG54 guidelines, including following them through 2011 to identify those with recurrent UTIs.
The numbers of children imaged, the imaging burden and efficiency, and urinary tract abnormalities detected by each guideline.
Fewer children would have been imaged by CG54 than RCP (150 vs 427), but its sensitivity was lower, at 44% for detecting scarring, 10% for identifying vesicoureteric reflux and 40% for other abnormalities. Overall, it would have only detected one-quarter of the abnormal cases (8 vs 32) and would have missed five of nine children with scarring, including three with multiple lesions and one with renal impairment. Imposing an age restriction of <8 years to the RCP guidelines would reduce its screening rate by 20% and still detect 90% of the abnormalities.
The CG54 guidelines do not alter the imaging efficiency compared to the RCP guidelines, but they are considerably less sensitive.
通过测量检测尿路异常的效率，比较 1991 年皇家内科医师学会（RCP）和 2007 年国家卫生与保健卓越研究所（NICE）（CG54）的儿童尿路感染（UTI）指南。
2008 年，根据 RCP 指南对纽卡斯尔初级保健信托基金（人口 70800 名儿童）内的 UTI 儿童进行转诊和成像，并将其与如果我们实施 CG54 指南将进行的活动进行比较，包括在 2011 年之前跟进以识别那些复发性 UTI 儿童。
两种指南下进行成像的儿童数量、成像负担和效率，以及每种指南检测到的尿路异常。
CG54 比 RCP 指南下进行成像的儿童数量更少（150 例比 427 例），但其敏感性较低，检测瘢痕形成的敏感性为 44%，检测膀胱输尿管反流的敏感性为 10%，检测其他异常的敏感性为 40%。总体而言，它只能检测到四分之一的异常病例（8 例比 32 例），并且会漏诊 9 例瘢痕形成儿童中的 5 例，包括 3 例多发性病变和 1 例肾功能不全。如果将 RCP 指南的年龄限制设定为<8 岁，则会降低其筛查率 20%，但仍能检测到 90%的异常。
CG54 指南与 RCP 指南相比并没有改变成像效率，但它们的敏感性要低得多。
