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首页> 外文期刊>Hong Kong Journal of Paediatrics >How Do the Revised Guidelines on Management of Urinary Tract Infection in Young Children Work in the Local Population?
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How Do the Revised Guidelines on Management of Urinary Tract Infection in Young Children Work in the Local Population?

机译：经修订的《幼儿尿路感染管理指南》在当地人口中如何发挥作用？

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The purpose of follow up imaging study after first febrile urinary tract infection (UTI) is to detect urological abnormalities that need timely diagnosis and treatment. Recent guidelines attempt to recommend imaging in high risk children while avoiding unnecessary investigation in children who do not need them. This study retrospectively surveyed a local cohort of 820 children who had first febrile UTI when aged below 24 months and who had underwent full imaging studies. Significant urological abnormalities were found in 58 patients (7.1%), including 9 requiring surgical treatment, 37 with grade IV-V vesicoureteral reflux (VUR) and 12 with severe renal scarring. Four imaging strategies were tested in terms of number of imaging needed and the risk of missing the 58 target patients: The first strategy (ultrasonography (USG) for all patients and voiding cystourethrogram (VCUG) for those with abnormal USG or UTI recurrence) would need VCUG in 87 patients and missed 24% of the target patients (1.7% of whole cohort). The second strategy (USG for all patients and VCUG for those with clinical risk factors or USG abnormalities or UTI recurrence) would require 272 patients undergoing VCUG and missed 12% of the target patients (0.8% of cohort). The third strategy (USG and a late dimercaptosuccinic acid (DMSA) scan for all patients, and VCUG for those with USG or DMSA abnormalities or UTI recurrence) would require 133 patients undergoing VCUG and missed 12% of the target patients (0.8% of whole cohort). The last strategy (USG and late DMSA for all patients, and VCUG for those with clinical risk factors or USG or DMSA abnormalities or UTI recurrence) would require 298 patients undergoing VCUG and missed 8.6% of the target patients (0.6% of whole cohort). Conclusion: It is clearly not cost-effective to do full imaging (USG, VCUG and DMSA) in all young children after first febrile UTI. However, the extent of workup depends on the doctors' and the parents' value judgement balancing the cost of imaging studies versus the risk of missing abnormalities. This report shows that UTI is indeed a signal of underlying abnormalities in 7.1% of patients. It also provides an estimate of the risk of missing such abnormalities with various imaging strategies. This will be useful for counselling parents on follow up plans for such children.
机译：首次发热性尿路感染（UTI）后的随访影像学研究的目的是发现需要及时诊断和治疗的泌尿系统异常。最近的指南试图建议对高危儿童进行影像检查，同时避免对不需要他们的儿童进行不必要的检查。这项研究回顾性调查了本地队列的820名儿童，这些儿童在24个月以下出生时首次出现高热性泌尿道感染，并接受了全面的影像学检查。在58例患者（7.1％）中发现了严重的泌尿外科异常，包括9例需要手术治疗，37例IV-V级膀胱输尿管反流（VUR）和12例严重肾脏瘢痕形成。根据所需的影像数量和错过58名目标患者的风险，对四种影像学策略进行了测试：第一种策略（所有患者的超声检查（USG）和USG或UTI复发异常的患者行膀胱尿道造影（VCUG）检查）将需要VCUG在87例患者中漏诊了24％的目标患者（占整个队列的1.7％）。第二种策略（对所有患者采用USG，对具有临床危险因素或USG异常或UTI复发的患者采用VCUG）将需要272例接受VCUG的患者，错过目标患者的12％（队列的0.8％）。第三种策略（对所有患者进行USG和晚期二巯基琥珀酸（DMSA）扫描，对USG或DMSA异常或UTI复发的患者进行VCUG扫描）将需要133例接受VCUG的患者，错过目标患者的12％（占总患者的0.8％队列）。最后一种策略（对所有患者采用USG和晚期DMSA，对具有临床风险因素或USG或DMSA异常或UTI复发的患者采用VCUG）将需要298例接受VCUG的患者，错过了8.6％的目标患者（占整个队列的0.6％） 。结论：在所有首次发热的UTI后对所有年幼儿童进行全面成像（USG，VCUG和DMSA）显然不符合成本效益。但是，检查的范围取决于医生和父母的价值判断，以平衡影像学检查的费用和遗漏异常的风险。该报告显示，在7.1％的患者中，UTI确实是潜在异常的信号。它还提供了使用各种成像策略错过此类异常的风险的估计。这对于为父母提供有关此类孩子的后续计划的咨询很有用。

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