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ABSTRACT Background: Urinary tract infection (UTI) is a common disease in childhood and one of the most common causes of consultation in the pediatric emergency department. Its incidence ranges between 5% and 10% in children under 2 years old. Objective: To generate recommendations on the diagnosis, treatment, and follow-up of UTI in pediatric patients in Colombia. Methods: 15 questions of clinical interest in the diagnosis, treatment, and follow-up of UTI in pediatric patients were formulated. A systematic review of the literature was carried out to identify the clinical practice guidelines (CPG) available in UTI, in order to use this evidence to answer the proposed questions and articulate the recommendations. Local and international tools were used to select and evaluate the CPGs. Information was retrieved from the selected guidelines, preliminary recommendations were compiled, and final recommendations were approved by expert consensus. Finally, the strength and direction of each recommendation was assessed. Results: A total of 4 CPGs were selected: American Academy of Pediatrics, Spanish Ministry of Health, McTaggart, and National Institute for Health and Care Excellence. Final recommendations for the diagnosis, treatment, and follow-up of UTI are presented in this paper. Conclusions: These recommendations will guide the teams to make clinical decisions regarding health care of pediatric patients with UTI in Colombia. This will help to improve health care and to generate policies for timely diagnosis, treatment, and follow-up in these patients.
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Introducción: El uso de dosis adecuadas de radiación en pacientes pediátricos es un deber de los centros de diagnóstico médico debido a las características y retos que implica esta población. Por lo anterior, se han establecido unos niveles internacionales de referencia de dosis (DRL, del inglés dose reference level) para optimizar y comparar los protocolos de cada institución. En Colombia no se cuenta con estudios al respecto. Objetivo: Mostrar los DRL utilizados en un hospital universitario de alta complejidad en las modalidades de tomografía computarizada (TC), radiografía y fluoroscopia y compararlos con los estándares internacionales. Metodología: Estudio descriptivo retrospectivo realizado entre 2018 y 2019. Se analizaron datos de producto dosis longitud (DLP) para TC de cráneo, tórax, abdomen y TC de tórax de alta resolución (TACAR); y producto dosis área (DAP) para radiografía de tórax, abdomen, huesos y fluoroscopia por grupos etarios. Resultados: Se obtuvieron los datos de 780 pacientes: 360 radiografías, 100 de fluoroscopia y 320 tomografías. Se encontró que los niveles de referencia de dosis de radiación usados en el hospital son bajos, comparados con guías europeas de 2018 de niveles de referencia. Se describen DRL para cada estudio y grupo etario. Conclusión: Se demostró que en el hospital donde hizo el estudio los niveles de referencia de radiación en la población pediátrica son bajos. El presente trabajo puede servir como referente nacional.
Introduction: Due to the characteristics and challenges of the pediatric population regarding radiation, the use of adequate doses of radiation is a duty of medical diagnostic centers. For this reason, the Dose Reference Levels (DRL) have been established in many countries to optimize and monitor the protocols of each institution. In Colombia there are no studies in this subject. Objective: To show the DRLs used in a university hospital of high complexity in the modalities of computed tomography (CT), radiography and fluoroscopy and to compare them with international standards. Methodology: Retrospective descriptive trial between 2018 and 2019. We analyzed dose length product (DLP) data for skull, chest, abdomen, and high-resolution chest CT (HRCT); and dose area product (DAP) for chest, abdomen, bone, and fluoroscopy radiography by age groups. Results: Data were collected for a total of 780 patients. 360 x-rays, 100 fluoroscopy and 320 tomography scans. Reference levels of radiation dose used in the hospital were found to be low compared to European guidelines of 2018 reference levels. DRLs are described for each study and age group. Conclusion: It was demonstrated that at the hospital where the study was conducted, reference levels of radiation in the pediatric population are low. This work can serve as a national reference.