PMID- 32495217
OWN - NLM
STAT- MEDLINE
DCOM- 20210324
LR  - 20210324
IS  - 0973-7693 (Electronic)
IS  - 0019-5456 (Linking)
VI  - 87
IP  - 12
DP  - 2020 Dec
TI  - Targeted Indication of Imaging for Detection of Vesicoureteric Reflux after 
      Pediatric Febrile Urinary Tract Infections Based on a Multiparametric 
      Computational Tool.
PG  - 1001-1008
LID - 10.1007/s12098-020-03329-5 [doi]
AB  - OBJECTIVES: 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). METHODS: 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. RESULTS: 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%. CONCLUSIONS: 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.
FAU - Roesch, Judith
AU  - Roesch J
AD  - Department of Pediatric Urology, Ordensklinikum Linz, Hospital of the Sisters of 
      Charity, Seilerstatte 4, 4020, Linz, Austria.
FAU - Harms, Mirjam
AU  - Harms M
AD  - Department of Pediatric Urology, Ordensklinikum Linz, Hospital of the Sisters of 
      Charity, Seilerstatte 4, 4020, Linz, Austria.
FAU - Berger, Christoph
AU  - Berger C
AD  - Department of Pediatric Urology, Ordensklinikum Linz, Hospital of the Sisters of 
      Charity, Seilerstatte 4, 4020, Linz, Austria.
FAU - Oswald, Josef
AU  - Oswald J
AD  - Department of Pediatric Urology, Ordensklinikum Linz, Hospital of the Sisters of 
      Charity, Seilerstatte 4, 4020, Linz, Austria.
FAU - Haid, Bernhard
AU  - Haid B
AUID- ORCID: 0000-0003-1691-7510
AD  - Department of Pediatric Urology, Ordensklinikum Linz, Hospital of the Sisters of 
      Charity, Seilerstatte 4, 4020, Linz, Austria. bernhard.haid@ordensklinikum.at.
AD  - Department of Urology, Ludwig Maximilians University (LMU), Munich, Germany. 
      bernhard.haid@ordensklinikum.at.
LA  - eng
PT  - Journal Article
DEP - 20200603
PL  - India
TA  - Indian J Pediatr
JT  - Indian journal of pediatrics
JID - 0417442
SB  - IM
CIN - Indian J Pediatr. 2020 Dec;87(12):989-990. PMID: 33047254
MH  - Child
MH  - Child, Preschool
MH  - Humans
MH  - Infant
MH  - Prospective Studies
MH  - Radionuclide Imaging
MH  - Retrospective Studies
MH  - Ultrasonography
MH  - *Urinary Tract Infections/diagnostic imaging
MH  - *Vesico-Ureteral Reflux/diagnostic imaging
OTO - NOTNLM
OT  - Pediatric urology. Imaging. Vesicoureteric reflux (VUR). Febrile urinary tract 
      infection (fUTI). Computational tool
EDAT- 2020/06/05 06:00
MHDA- 2021/03/25 06:00
CRDT- 2020/06/05 06:00
PHST- 2019/08/12 00:00 [received]
PHST- 2020/04/29 00:00 [accepted]
PHST- 2020/06/05 06:00 [pubmed]
PHST- 2021/03/25 06:00 [medline]
PHST- 2020/06/05 06:00 [entrez]
AID - 10.1007/s12098-020-03329-5 [pii]
AID - 10.1007/s12098-020-03329-5 [doi]
PST - ppublish
SO  - Indian J Pediatr. 2020 Dec;87(12):1001-1008. doi: 10.1007/s12098-020-03329-5. 
      Epub 2020 Jun 3.