Children's Hospital of Philadelphia, Perelman School of Medicine University of Pennsylvania, USA.
Children's Hospital of Philadelphia, Perelman School of Medicine University of Pennsylvania, USA.
J Pediatr Urol. 2023 Oct;19(5):542.e1-542.e7. doi: 10.1016/j.jpurol.2023.07.012. Epub 2023 Jul 24.
Non-neurogenic lower urinary tract dysfunction (LUTD) is one of the most common reasons for presentation to a pediatric urologist, affecting up to 20% of children. Predicting who will benefit from RBUS as part of their work-up is challenging as the majority will have normal imaging.
Our objective was to assess the utility of using the Dysfunctional Voiding and Incontinence Scoring System (DVISS) and urinary tract infection (UTI) history to predict which LUTD patients were most likely to have an abnormal RBUS as well as determine a DVISS cutoff to aid in making this prediction. We hypothesized that higher DVISS scores and a positive urinary tract infection (UTI) history would be associated with increased likelihood of RBUS abnormality.
We retrospectively reviewed outpatients seen for LUTD from 5/2014-1/2016 who received an RBUS. Association between prior UTI, DVISS score, gender, and race and RBUS abnormality were evaluated using logistic regression analysis. Receiver operating characteristic (ROC) curves were created to evaluate the predictive model and a Youden index calculated to determine the optimal cutoff for DVISS score to predict abnormal RBUS.
15 of 333 patients (4.5%) had a clinically significant RBUS abnormality. Significantly more patients with abnormal RBUS had a positive UTI history and median DVISS was higher. UTI history and DVISS score were associated with RBUS abnormality whereas neither gender nor race were. A DVISS score cutoff of 12 was determined to be ideal for predicting abnormal imaging. Using DVISS≥12 and positive UTI history, patients with both risk factors were significantly more likely to have an abnormal RBUS than those with zero or one risk factor (Figure).
To the best of our knowledge this is the first study to try to identify risk factors associated with RBUS abnormality in pediatric LUTD patients and create an evidence-based approach to imaging these patients. We found both DVISS cutoff ≥12 and positive UTI history to be useful to risk stratify LUTD patients' likelihood of abnormal RBUS. Limitations include the study's retrospective nature as well as the fact the population was drawn from a tertiary care pediatric hospital with a large referral population and the fact that the decision to order an RBUS was based on individual clinician preference and decision making.
We found that DVISS score≥12 and UTI history are useful in guiding the decision to obtain RBUS in pediatric LUTD patients.
非神经源性下尿路功能障碍（LUTD）是小儿泌尿科就诊的最常见原因之一，影响多达 20%的儿童。预测哪些患者将从 RBUS 检查中受益具有挑战性，因为大多数患者的影像学检查都正常。
我们的目的是评估使用排尿功能障碍和尿失禁评分系统（DVISS）和尿路感染（UTI）病史来预测哪些 LUTD 患者最有可能出现异常 RBUS 的效用，并确定 DVISS 截断值以帮助做出此预测。我们假设更高的 DVISS 评分和阳性尿路感染（UTI）病史与 RBUS 异常的可能性增加相关。
我们回顾性分析了 2014 年 5 月至 2016 年 1 月期间因 LUTD 就诊并接受 RBUS 检查的门诊患者。使用逻辑回归分析评估先前 UTI、DVISS 评分、性别和种族与 RBUS 异常之间的关系。创建了受试者工作特征（ROC）曲线来评估预测模型，并计算了约登指数以确定 DVISS 评分预测异常 RBUS 的最佳截断值。
333 例患者中有 15 例（4.5%）RBUS 异常。异常 RBUS 的患者明显有更多的 UTI 病史，且中位数 DVISS 更高。UTI 病史和 DVISS 评分与 RBUS 异常相关，而性别和种族则没有。确定 DVISS 评分为 12 为预测异常影像学的理想截断值。使用 DVISS≥12 和阳性 UTI 病史，同时具有这两个危险因素的患者发生异常 RBUS 的可能性明显高于只有一个或没有危险因素的患者（图）。
据我们所知，这是第一项试图确定与小儿 LUTD 患者 RBUS 异常相关的危险因素并为这些患者进行影像学检查创建循证方法的研究。我们发现，DVISS 截断值≥12 和阳性 UTI 病史都有助于对 LUTD 患者的 RBUS 异常可能性进行风险分层。局限性包括研究的回顾性性质，以及人群来自大型转诊人群的三级儿童医院，以及决定进行 RBUS 检查的决定是基于个别临床医生的偏好和决策。
我们发现，在小儿 LUTD 患者中，DVISS 评分≥12 和 UTI 病史有助于指导获得 RBUS 的决策。
