Top-Down versus Bottom-Up Approach in Children Presenting with Urinary Tract Infection: Comparative Effectiveness Analysis Using RIVUR and CUTIE Data. Reply.

2022 ◽  
Author(s):  
Hsin-Hsiao Scott Wang ◽  
Caleb Nelson
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Comparative Effectiveness ◽  
Top Down ◽  
Bottom Up ◽  
Effectiveness Analysis ◽  
Comparative Effectiveness Analysis

scholarly journals Radiographic Evaluation of Children with Febrile Urinary Tract Infection: Bottom-Up, Top-Down, or None of the Above?

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Michaella M. Prasad ◽  
Earl Y. Cheng
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Renal Scarring ◽  
Radiographic Evaluation ◽  
Voiding Cystourethrogram ◽  
Top Down ◽  
Febrile Urinary Tract Infection ◽  
Bottom Up ◽  
Advantages And Disadvantages

The proper algorithm for the radiographic evaluation of children with febrile urinary tract infection (FUTI) is hotly debated. Three studies are commonly administered: renal-bladder ultrasound (RUS), voiding cystourethrogram (VCUG), and dimercapto-succinic acid (DMSA) scan. However, the order in which these tests are obtained depends on the methodology followed: bottom-up or top-down. Each strategy carries advantages and disadvantages, and some groups now advocate even less of a workup (none of the above) due to the current controversies about treatment when abnormalities are diagnosed. New technology is available and still under investigation, but it may help to clarify the interplay between vesicoureteral reflux, renal scarring, and dysfunctional elimination in the future.

scholarly journals Economic and Radiation Costs of Initial Imaging Approaches After a Child’s First Febrile Urinary Tract Infection

2011 ◽  
Vol 51 (1) ◽  
pp. 23-30 ◽  
Author(s):  
Jonathan C. Routh ◽  
Frederick D. Grant ◽  
Paul J. Kokorowski ◽  
Caleb P. Nelson ◽  
Frederic H. Fahey ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Radiation Doses ◽  
Top Down ◽  
Effective Radiation Dose ◽  
Bottom Up ◽  
Imaging Approach ◽  
Initial Imaging ◽  
Effective Radiation

Background. The traditional initial imaging approach following pediatric urinary tract infection is the “bottom-up” approach (cystogram and renal ultrasound). Recently, the “top-down” approach (nuclear renal scan followed by cystogram for abnormal scans only) has gained increasing attention. The relative cost and radiation doses of these are unknown Methods. The authors used a decision model to evaluate these imaging approaches. Cost and effective radiation dose estimates, including sensitivity analyses, were based on one-time imaging only. Results. Comparing hypothetical cohorts of 100 000 children, the top-down imaging approach cost $82.9 million versus $59.2 million for the bottom-up approach. Per-capita effective radiation dose was 0.72 mSv for top-down compared with 0.06 mSv for bottom-up. Conclusions. Routine use of nuclear renal scans in children following initial urinary tract infection diagnosis would result in increased imaging costs and radiation doses as compared to initial cystogram and ultrasound. Further data are required to clarify the long-term clinical implications of this increase.

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