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Targeted Indication of Imaging for Detection of Vesicoureteric Reflux after Pediatric Febrile Urinary Tract Infections Based on a Multiparametric Computational Tool

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Abstract

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.

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Acknowledgements

The authors would like to express their gratitude to Dr. Wolfgang Schimetta, who performed the statistics and the programming for the computational tool as presented in this paper. Furthermore, they would like to thank all the members of the staff of the Department of Pediatric Urology, Ordensklinikum Linz, Hospital of the Sisters of Charity for their ongoing support of scientific activities.

Authors’ Contributions

JR, BH, CB: Data acquisition and analysis; JR, BH, CB, MH: Manuscript drafting; JO: Supervision.

The study protocol was approved by the ethics committee of The Hospital of the Sisters of Charity Linz (EK23/14).

Availability of Original Data

The original data used for this research are available on Zenodo (https://zenodo.org/record/3722886#.XnXj0S1oSL4, doi: https://doi.org/10.5281/zenodo.3722886).

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Authors and Affiliations

  1. Department of Pediatric Urology, Ordensklinikum Linz, Hospital of the Sisters of Charity, Seilerstätte 4, 4020, Linz, Austria

    Judith Roesch, Mirjam Harms, Christoph Berger, Josef Oswald & Bernhard Haid

  2. Department of Urology, Ludwig Maximilians University (LMU), Munich, Germany

    Bernhard Haid

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  1. Judith Roesch
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Correspondence to Bernhard Haid.

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Roesch, J., Harms, M., Berger, C. et al. Targeted Indication of Imaging for Detection of Vesicoureteric Reflux after Pediatric Febrile Urinary Tract Infections Based on a Multiparametric Computational Tool. Indian J Pediatr 87, 1001–1008 (2020). https://doi.org/10.1007/s12098-020-03329-5

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