Prediction of vesicoureteral reflux after a first febrile urinary tract infection in children: validation of a clinical decision rule
- PMID: 15890693
- PMCID: PMC2065936
- DOI: 10.1136/adc.2004.068205
Prediction of vesicoureteral reflux after a first febrile urinary tract infection in children: validation of a clinical decision rule
Abstract
Aims: To test the reproducibility of a highly sensitive clinical decision rule proposed to predict vesicoureteral reflux (VUR) after a first febrile urinary tract infection in children. This rule combines clinical (family history of uropathology, male gender, young age), biological (raised C reactive protein), and radiological (urinary tract dilation on renal ultrasound) predictors in a score, and provides 100% sensitivity.
Methods: A retrospective hospital based cohort study included all children, 1 month to 4 years old, with a first febrile urinary tract infection. The sensitivities and specificities of the rule at the two previously proposed score thresholds (< or =0 and < or =5) to predict respectively, all-grade or grade > or =3 VUR, were calculated.
Results: A total of 149 children were included. VUR prevalence was 25%. The rule yielded 100% sensitivity and 3% specificity for all-grade VUR, and 93% sensitivity and 13% specificity for grade > or =3 VUR. Some methodological weaknesses explain this lack of reproducibility.
Conclusions: The reproducibility of the previously proposed decision rule was poor and its potential contribution to clinical management of children with febrile urinary tract infection seems to be modest.
Conflict of interest statement
Competing interests: none declared
Comment in
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Can we predict vesicoureteric reflux?Arch Dis Child. 2006 Mar;91(3):210-1. doi: 10.1136/adc.2005.086892. Arch Dis Child. 2006. PMID: 16492883 Free PMC article. Review.
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- American Academy of Pediatrics Committee on Quality Improvement. Subcommittee on Urinary Tract Infection. Practice parameter: the diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children, Pediatrics 1999103843–852. - PubMed
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