{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T12:53:42Z","timestamp":1791204822067,"version":"4.1.0"},"reference-count":60,"publisher":"American Academy of Pediatrics (AAP)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,1]]},"abstract":"\n BACKGROUND<\/jats:title>\n Vesicoureteral reflux (VUR) may be present in as many as 40% of children without known underlying neurogenic bladder or anatomic abnormalities in whom a first urinary tract infection (UTI) is diagnosed. This article reports on a technical review investigating the diagnosis of VUR using renal and bladder ultrasonography (RBUS) to inform the development of an updated clinical practice guideline (CPG) by the American Academy of Pediatrics.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n The authors performed a systematic review to evaluate the diagnostic test accuracy (DTA) of RBUS for the detection of VUR in pediatric patients following either their first UTI or recurrent UTI. We performed database searches of Medline via PubMed, Embase, and Cochrane Central Register of Controlled Trials from January 1, 2008, through August 5, 2023. Eligible studies were published in English and reported on DTA for RBUS performed in pediatric patients with an acceptable\u00a0reference standard. Data on study characteristics and DTA parameters were extracted from studies and pooled using meta-analysis, when appropriate. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Out of 857 identified records, a total of 90 studies were included. Overall, there is low-to-moderate certainty that RBUS lacks accuracy in detecting VUR in children with their first UTI and low certainty that RBUS lacks accuracy in detecting VUR in children with recurrent UTI. The pooled sensitivity and specificity for children with their first UTI are 50% (95% confidence interval [CI], 42% to 58%) and 71% (95% CI, 62% to 78%), respectively. Accuracy does not substantially improve when restricted to the detection of high-grade (III-V) VUR (sensitivity: 66% [95% CI, 60% to 72%], specificity: 77% [95% CI, 71% to 82%]) or to children with recurrent UTI (sensitivity: 26% [95% CI, 23% to 28%], specificity: 79% [95% CI 76% to 81%]).<\/jats:p>\n <\/jats:sec>\n \n CONCLUSION<\/jats:title>\n This systematic review illustrates the unreliability of RBUS as a stand-alone test in detecting VUR in a variety of scenarios. These results informed the development of an updated AAP CPG on the management of pediatric UTI. Specific areas of uncertainty identified through this review may be addressed with future research.<\/jats:p>\n <\/jats:sec>","DOI":"10.1542\/peds.2026-078567","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:02:36Z","timestamp":1790553756000},"source":"Crossref","is-referenced-by-count":1,"title":["A Systematic Review and Meta-Analysis of the Role of Ultrasonography for the Diagnosis of Vesicoureteral Reflux in Pediatric Patients Following Urinary Tract Infections: Technical Report"],"prefix":"10.1542","volume":"158","author":[{"given":"Muayad","family":"Azzam","sequence":"first","affiliation":[{"name":"1Evidence-Based Practice and Impact Center, University of Kansas Medical Center, Kansas City, Kansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Choaib","sequence":"additional","affiliation":[{"name":"1Evidence-Based Practice and Impact Center, University of Kansas Medical Center, Kansas City, Kansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamil","family":"Nazzal","sequence":"additional","affiliation":[{"name":"1Evidence-Based Practice and Impact Center, University of Kansas Medical Center, Kansas City, Kansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin Z.","family":"Amarin","sequence":"additional","affiliation":[{"name":"2Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee"},{"name":"3Epidemiology Doctoral Program, School of Medicine, Vanderbilt University, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Senerth","sequence":"additional","affiliation":[{"name":"4Evidence Foundation, Cleveland Heights, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine S.","family":"Forster","sequence":"additional","affiliation":[{"name":"5Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad","family":"Sofi-Mahmudi","sequence":"additional","affiliation":[{"name":"6Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leena","family":"AlShenaiber","sequence":"additional","affiliation":[{"name":"4Evidence Foundation, Cleveland Heights, Ohio"},{"name":"7College of Medicine and Health Sciences, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Volf","family":"Gaby","sequence":"additional","affiliation":[{"name":"4Evidence Foundation, Cleveland Heights, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neha","family":"Tangri","sequence":"additional","affiliation":[{"name":"4Evidence Foundation, Cleveland Heights, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Pilcher","sequence":"additional","affiliation":[{"name":"8Department of Child Health Finance and Quality, American Academy of Pediatrics, Itasca, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca L.","family":"Morgan","sequence":"additional","affiliation":[{"name":"4Evidence Foundation, Cleveland Heights, Ohio"},{"name":"6Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada"},{"name":"9Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reem A.","family":"Mustafa","sequence":"additional","affiliation":[{"name":"1Evidence-Based Practice and Impact Center, University of Kansas Medical Center, Kansas City, Kansas"},{"name":"4Evidence Foundation, Cleveland Heights, Ohio"},{"name":"6Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada"},{"name":"10Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas, Kansas City, Kansas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"issue":"3","key":"2026100508171136300_r1","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1097\/RLU.0b013e318279f112","article-title":"Acute 99mTc DMSA scan predicts dilating vesicoureteral reflux in young children with a first febrile urinary tract infection: a population-based cohort study","volume":"38","author":"Sheu","year":"2013","journal-title":"Clin Nucl Med."},{"issue":"8","key":"2026100508171136300_r2","doi-asserted-by":"crossref","first-page":"536","DOI":"10.4111\/kju.2014.55.8.536","article-title":"Are clinical, laboratory, and imaging markers suitable predictors of vesicoureteral 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