With the use of the most relaxed criteria (25% abnormal), US had a sensitivity of 28% (specificity of 77%), and with the most stringent criteria (4% abnormal), US had a sensitivity of 5% (specificity of 97%) [31]. Assuming a 40% prevalence of VUR and a 20% recurrent rate of UTIs in 100 children who have US, up to 11 children will have positive US studies that will be followed by a VCUG study, of which 8 will be positive for VUR. Two years of a prophylactic antibiotic will decrease recurrent UTIs from up to 2 children to 1 child. This means that 1 child will benefit from the US study and an additional 3 children that may benefit from prophylactic antibiotic will not be treated. In addition, with the increased use of prenatal US screening, the yield of detection of unknown renal abnormalities in children with UTIs has decreased [73]. Few studies with small series of children suggest good correlation between power Doppler US and Tc-99m DMSA findings of pyelonephritis [74,75]. Other studies; however, demonstrated a low sensitivity for pyelonephritis and a low prediction for development of renal scarring [49,76,77]. Therefore, the use of power Doppler US as a replacement for nuclear medicine cystography is not useful [26,49,76]. The NICE guidelines for UTI recommend US if the infection is atypical for all ages or recurrent [16]. The AAP guidelines recommend US for children with a febrile UTI from ages 2 to 24 months [41]. Urinary Tract Infection-Child Variant 6: Child. Established vesicoureteral reflux. Follow-up imaging. CT Abdomen and Pelvis With IV Contrast There is no relevant literature to support the use of CT abdomen and pelvis with IV contrast in the evaluation of a child with established VUR for follow-up imaging. CT Abdomen and Pelvis Without and With IV Contrast There is no relevant literature to support the use of CT abdomen and pelvis without and with IV contrast in the evaluation of a child with established VUR for follow-up imaging.
Urinary Tract Infection Child. With the use of the most relaxed criteria (25% abnormal), US had a sensitivity of 28% (specificity of 77%), and with the most stringent criteria (4% abnormal), US had a sensitivity of 5% (specificity of 97%) [31]. Assuming a 40% prevalence of VUR and a 20% recurrent rate of UTIs in 100 children who have US, up to 11 children will have positive US studies that will be followed by a VCUG study, of which 8 will be positive for VUR. Two years of a prophylactic antibiotic will decrease recurrent UTIs from up to 2 children to 1 child. This means that 1 child will benefit from the US study and an additional 3 children that may benefit from prophylactic antibiotic will not be treated. In addition, with the increased use of prenatal US screening, the yield of detection of unknown renal abnormalities in children with UTIs has decreased [73]. Few studies with small series of children suggest good correlation between power Doppler US and Tc-99m DMSA findings of pyelonephritis [74,75]. Other studies; however, demonstrated a low sensitivity for pyelonephritis and a low prediction for development of renal scarring [49,76,77]. Therefore, the use of power Doppler US as a replacement for nuclear medicine cystography is not useful [26,49,76]. The NICE guidelines for UTI recommend US if the infection is atypical for all ages or recurrent [16]. The AAP guidelines recommend US for children with a febrile UTI from ages 2 to 24 months [41]. Urinary Tract Infection-Child Variant 6: Child. Established vesicoureteral reflux. Follow-up imaging. CT Abdomen and Pelvis With IV Contrast There is no relevant literature to support the use of CT abdomen and pelvis with IV contrast in the evaluation of a child with established VUR for follow-up imaging. CT Abdomen and Pelvis Without and With IV Contrast There is no relevant literature to support the use of CT abdomen and pelvis without and with IV contrast in the evaluation of a child with established VUR for follow-up imaging.