{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T13:33:32Z","timestamp":1790602412156,"version":"4.1.0"},"reference-count":26,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2019,6,26]],"date-time":"2019-06-26T00:00:00Z","timestamp":1561507200000},"content-version":"vor","delay-in-days":25,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatrics International"],"published-print":{"date-parts":[[2019,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>There is confusion surrounding the precise indications for voiding cystourethrography (<jats:styled-content style=\"fixed-case\">VCUG<\/jats:styled-content>) during the assessment of vesicoureteral reflex (<jats:styled-content style=\"fixed-case\">VUR<\/jats:styled-content>) after a first febrile urinary tract infection (<jats:styled-content style=\"fixed-case\">UTI<\/jats:styled-content>). The aim of this study was to determine the combination of clinical, laboratory and ultrasonography factors correlating with grades <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content>\u2013V <jats:styled-content style=\"fixed-case\">VUR<\/jats:styled-content> in young children with a first febrile <jats:styled-content style=\"fixed-case\">UTI<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Children 0\u201324 months of age who were brought to the emergency department at National Center for Child Health and Development with the diagnosis of first time febrile <jats:styled-content style=\"fixed-case\">UTI<\/jats:styled-content> between March 2004 and May 2011, were enrolled. We compared clinical, laboratory and ultrasonography findings between children with grades <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content>\u2013V <jats:styled-content style=\"fixed-case\">VUR<\/jats:styled-content> (high\u2010grade <jats:styled-content style=\"fixed-case\">VUR<\/jats:styled-content>) and those with no or grades I\u2013<jats:styled-content style=\"fixed-case\">III VUR<\/jats:styled-content> (normal or low\u2010grade <jats:styled-content style=\"fixed-case\">VUR<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 231 patients were eligible and 19 had high\u2010grade <jats:styled-content style=\"fixed-case\">VUR<\/jats:styled-content>. Poor clinical appearance, presence of a uropathogen other than <jats:italic>Escherichia coli<\/jats:italic>, positive blood culture, hydroureter and thickened renal pelvic wall were all independently associated with high\u2010grade <jats:styled-content style=\"fixed-case\">VUR<\/jats:styled-content>. When one or more of these factors were present, sensitivity, specificity, positive or negative predictive value, and positive or negative likelihood ratio were 94.7%, 69.4%, 23.1%, 99.3%, 3.1 and 0.1, respectively. When none of the factors was present, the proportion of high\u2010grade <jats:styled-content style=\"fixed-case\">VUR<\/jats:styled-content> was 0.7%; if one factor, 11.3%; two factors, 55.6%; three factors, 85.7%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In the absence of five specific factors during the first febrile <jats:styled-content style=\"fixed-case\">UTI<\/jats:styled-content> episode in young children, <jats:styled-content style=\"fixed-case\">VCUG<\/jats:styled-content> is not necessary to detect high\u2010grade <jats:styled-content style=\"fixed-case\">VUR<\/jats:styled-content>. When more than one factor is present, however, <jats:styled-content style=\"fixed-case\">VCUG<\/jats:styled-content> is indicated.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ped.13835","type":"journal-article","created":{"date-parts":[[2019,3,20]],"date-time":"2019-03-20T02:17:53Z","timestamp":1553048273000},"page":"595-600","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Indication for voiding cystourethrography during first urinary tract infection"],"prefix":"10.1111","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4652-5748","authenticated-orcid":false,"given":"Yoshinori","family":"Kobayashi","sequence":"first","affiliation":[{"name":"Department of General Pediatrics and Interdisciplinary Medicine National Center for Child Health and Development Setagaya Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroki","family":"Mishina","sequence":"additional","affiliation":[{"name":"Department of General Pediatrics and Interdisciplinary Medicine National Center for Child Health and Development Setagaya Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3091-114X","authenticated-orcid":false,"given":"Nobuaki","family":"Michihata","sequence":"additional","affiliation":[{"name":"Department of Postgraduate Education and Training National Center for Child Health and Development Setagaya Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikiko","family":"Miyasaka","sequence":"additional","affiliation":[{"name":"Department of Radiology National Center for Child Health and Development Setagaya Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John Ichiro","family":"Takayama","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of California San Francisco San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,6,26]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1007755"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2014.637"},{"key":"e_1_2_9_4_1","unstructured":"National Institute for Health and Clinical Excellence.Urinary Tract Infection in Under 16s: Diagnosis and Management. 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