Department of Pediatric Urology, Ordensklinikum Linz, Hospital of the Sisters of Charity, Seilerstätte 4, 4020, Linz, Austria.
Department of Urology, Ludwig Maximilians University (LMU), Munich, Germany.
Indian J Pediatr. 2020 Dec;87(12):1001-1008. doi: 10.1007/s12098-020-03329-5. Epub 2020 Jun 3.
Diagnostic workup after febrile urinary tract infections (fUTIs) in children remains a matter of debate. The authors aimed to evaluate multiple parameters in order to design a predictive tool enabling a targeted indication of voiding cystourethrography (VCUG).
Records of 383 consecutive children who underwent a VCUG as well as a dimercaptosuccinic-acid (DMSA) scan after febrile urinary tract infections (fUTIs) at a single institution between 04/2009 and 06/2014 were reviewed. Twenty parameters were recorded. After regression analysis, 6 parameters were incorporated into a computational tool aiming at a targeted indication of an eventual VCUG. The performance of the tool was prospectively tested on 100 patients.
Postpyelonephritic alterations on DMSA, duplex systems, age 1-3 y, duration of fever >3 d, >2 fUTIs before VCUG and abnormal sonography findings were identified as significant predictors (p < 0.05 each); the presence of bladder and bowel dysfunction (BBD) was negatively associated with vesicoureteric reflux (VUR). The resulting computational tool achieved an Area under the curve (AUC) of 0.686 (CI 0.633-0.740). Prospective evaluation (100 new patients) revealed a sensitivity of 85.1%, a specificity of 49.1%, a positive predictive value of 59.7% and a negative predictive value of 78.7%.
The differentiated indication of a VCUG based on the use of a tool was efficient in optimizing the specificity of the diagnostic algorithm after fUTIs. The tool outperformed other common clinical approaches in terms of VUR detection and VCUG frequency. After validation and further refinement in a multicentric approach, this strategy could significantly enhance VUR detection whilst reducing the number of VCUGs.
儿童发热性尿路感染（fUTI）后的诊断方法仍存在争议。作者旨在评估多个参数，以设计一种预测工具，从而能够针对特定的适应证进行排尿性膀胱尿道造影（VCUG）。
回顾了 2009 年 4 月至 2014 年 6 月期间在一家机构中因 fUTI 而接受 VCUG 和二巯丁二酸（DMSA）扫描的 383 例连续患儿的记录。记录了 20 个参数。经过回归分析，将 6 个参数纳入了一种计算工具中，旨在针对可能的 VCUG 进行针对性的适应证。该工具在 100 例患者中进行了前瞻性测试。
DMSA 上肾盂肾炎后的改变、双肾盂系统、1-3 岁年龄、发热持续时间>3 天、VCUG 前>2 次 fUTI 和异常超声发现被确定为显著预测因素（p<0.05）；膀胱和肠道功能障碍（BBD）的存在与膀胱输尿管反流（VUR）呈负相关。由此产生的计算工具的曲线下面积（AUC）为 0.686（CI 0.633-0.740）。前瞻性评估（100 例新患者）显示敏感性为 85.1%，特异性为 49.1%，阳性预测值为 59.7%，阴性预测值为 78.7%。
基于工具使用的 VCUG 差异化适应证在优化 fUTI 后的诊断算法特异性方面是有效的。该工具在 VUR 检测和 VCUG 频率方面优于其他常见的临床方法。在多中心方法中验证和进一步完善后，这种策略可以显著提高 VUR 检测率，同时减少 VCUG 的数量。
