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Acute phase DMSA renal cortical scintigraphy for identifying dilating vesicoureteral reflux in children with a first febrile urinary tract infection: a diagnostic test accuracy meta-analysis

Abstract number: R2495

Mantadakis E., Vouloumanou E., Georgantzi G., Tsalkidis A., Chatzimichael A., Falagas M.

Objective: Controversy exists regarding the type and/or sequence of imaging studies needed during the first febrile urinary tract infection (UTI) in young children. Several investigators claim that since acute phase Tc-99m dimercaptosuccinic acid (DMSA) renal scan results are abnormal when there is dilating vesicoureteral reflux (VUR), a normal DMSA scan makes voiding cystourethrography (VCUG) unnecessary in the primary examination of infants with UTI. We aimed to evaluate the accuracy of acute phase DMSA scan in identifying dilating (grades III-V) VUR documented by VCUG in children with a first febrile UTI.

Methods: We performed a diagnostic test accuracy meta-analysis of relevant studies identified through the PubMed and Scopus databases. Two separate analyses, patient-based and renal units-based, were performed.

Results: Overall, 13 cohort studies were identified. Nine studies involved patients <2 years old, 3 children leqslant R: less-than-or-eq, slant16 years, and 1 involved exclusively neonates. Females constituted 22% to 85% of the involved children. Pooled (95% confidence intervals) sensitivity and specificity of DMSA scan was 79% and 53%, respectively for the patient-based analyses (8 studies) and 60% and 65% for the renal units-based analysis (5 studies). The respective areas under the hierarchical summary receiver operating curves were 0.67 and 0.66. Marked statistical heterogeneity was observed in both analyses, as indicated by an I2 index value of 91% and 87%, respectively.

Conclusion: Acute phase DMSA renal scan cannot be recommended as replacement for VCUG in the evaluation of young children with a first febrile UTI.

Session Details

Date: 07/05/2011
Time: 00:00-00:00
Session name: Abstracts of 21st ECCMID / 27th ICC
Subject:
Location: Milan, Italy, 7 - 10 May 2011
Presentation type:
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