Algorithms imaging tests comparison following the first febrile urinary tract infection in children.

OBJETIVES: To compare the diagnostic sensitivity, costs and radiation doses of imaging tests algorithms developed by the Argentine Society of Pediatrics in 2003 and 2015, against British and American guidelines after the first febrile urinary tract infection (UTI). POPULATION AND METHODS: Inclusion criteria: children ≤ 2 years old with their first febrile UTI and normal ultrasound, voiding cystourethrography and dimercaptosuccinic acid scintigraphy, according to the algorithm established by the Argentine Society of Pediatrics in 2003, treated between 2003 and 2010. The comparisons between algorithms were carried out through retrospective simulation. RESULTADOS: 80 pacientes cumplieron con los criterios de inclusion; 51 (63%) presentaron reflujo vesicoureteral (RVU); 6% de alto grado; escaras en 6 (7,5%); costo: 404 000 $; radiacion: 160 milisievert. Aplicando el algoritmo de la Sociedad Argentina de Pediatria de 2015, se hubiera omitido el diagnostico de 4 RVU y 2 escaras, con un costo de 301 800 $ y 124 milisievert de radiacion. Las guias britanicas y americanas hubieran omitido los diagnosticos de todos los RVU y escaras con costos de 23 000 $ y 40 000 $, respectivamente, y 0 de radiacion. CONCLUSION: Intensive protocols are highly sensitive to VUR and renal scarring, but they imply high costs and doses of radiation, and result in questionable benefits.