The accuracy of renal point of care ultrasound to detect hydronephrosis in children with a urinary tract infection

Abstract

The objective of this study was to investigate the accuracy of renal point of care ultrasound (POCUS) for the detection of hydronephrosis in children with a urinary tract infection (UTI). We prospectively included all patients with a final diagnosis of UTI who visited our pediatric emergency department between November 2009 and April 2011. Emergency physicians were encouraged to perform a renal POCUS during these visits, and a follow-up renal ultrasonography was performed by a radiologist who was blinded to the results of POCUS. We calculated the accuracy of POCUS to detect hydronephrosis (renal pelvis enlargement ≥10 mm). We included 433 UTI visits, and 382 (88.2%) POCUS were performed. The sensitivity and the specificity were 76.5% (95% confidence interval: 58.1-94.6%) and 97.2% (95.2-99.2%), respectively. The positive and the negative predictive values were 59.1% (36.4-79.3%) and 98.8% (97.7-99.9%), respectively. Renal POCUS might be used to rule out hydronephrosis in pediatric UTI.

Point-of-care ultrasound in primary care: a systematic review of generalist performed point-of-care ultrasound in unselected populations

“…in % (95% CI)Sp. in % (95% CI)LR+ (95% CI)LR− (95% CI) Hydronephrosis/nephrolithiasis Wong et al [ 113 ] EP 2018 MA ( 9 ) NR 1773 35 – 84 NR CT, visualisation of stone or surgical findings 70.2 ( 67.1 – 73.2 ) 75.4 ( 72.5 – 78.2 ) 2.85 0.39 Javaudin et al [114]EP2017France16 h.503847Radiologist US100 (82–100)71 (52–86)3.4 (2.0–6.0)0Pediatric hydronephrosis in UTIGuedj et al [115]EP2015France2 h.38259 m.Radiologist US76.5 (58.1–94.6)97.2 (95.2–99.2)27.30.25Scrotal pathologyBlaivas et al [118]EP2001USANR365845Radiologist colour doppler US95 (78–99)94 (72–99)16 a 0.053 a CholelithiasisEsquerrà et al [121]GP2012Spain212 h.11556NRRadiologist US88.9 (83.2–94.6)100 (NR)∞ a 0.111Lindgaard and Risgaard [9...…”

“…One study not included in this meta-analysis found 100% sensitivity, but moderate specificity [114]. A French study found that EPs correctly identified hydronephrosis in children with urinary tract infections (prevalence = 5%) with a sensitivity of 76.5% and a specificity of 97.2% [115]. Finally, one large ( n = 2759) study, randomising patients into diagnosis through EP PoCUS, radiologist ultrasound or computed tomography (CT), found no difference in high-risk diagnoses that could be due to missed or delayed diagnosis after 30 days, and showed overall lower cumulative radiation exposure at 6 months for both ultrasound groups compared to the CT group [116].…”

Point-of-Care Ultrasound for the Pediatric Hospitalist’s Practice

“…80 In pediatric patients, the cornerstone for the evaluation for hydronephrosis is radiology-performed ultrasound. Guedj et al 81 patients with nephrolithiasis, the goal is to evaluate for the presence of hydronephrosis secondary to an obstructing stone. Radiology-performed ultrasound has been shown to be 66.7% sensitive (95% CI: 48.8% to 80.8%) and 97.4 specific (95% CI: 86.8% to 99.9%) for detecting stones, with a falsenegative rate of 59%.There is a paucity of pediatric-specific literature in which researchers assessed suspected nephrolithiasis, particularly in comparison with CT. 82,83 Although imaging may not be necessary in the acute setting, POCUS could be a useful screening tool for hospitalized patients who fail to respond to medical management.…”

Deuxième niveau de compétence pour l’échographie clinique en médecine d’urgence. Recommandations de la Société française de médecine d’urgence par consensus formalisé

“…Une étude a comparé l'échographie faite par un urgentiste et un radiologue pour la détection d'une dilatation rénale. Les RV+ et RV-de l'échographie faite par l'urgentiste sont respectivement de 27 et 0,2 [70]. Pour autant, l'échographie rénale est peu sensible pour le diagnostic d'anomalies rénales comparée à la cystographie [71].…”