ORIGINAL ARTICLE

Prediction of vesicoureteral reflux after a first febrile urinary tract infection in children: validation of a clinical decision rule

S Leroy¹, E Marc², C Adamsbaum³, D Gendrel¹, G Bréart⁴, M Chalumeau⁴

¹ Clinical Epidemiology Unit, Department of Paediatrics, Saint-Vincent-de-Paul Hospital, AP-HP, Université Paris V, Paris, France
² Department of Emergency Medicine, Saint-Vincent-de-Paul Hospital, AP-HP, Université Paris V, Paris, France
³ Department of Radiology, Saint-Vincent-de-Paul Hospital, AP-HP, Université Paris V, Paris, France
⁴ INSERM U149, Paris, France

Correspondence to:
Dr M Chalumeau
Clinical Epidemiology Unit, Department of Paediatrics, Saint-Vincent-de-Paul Hospital, 74–82 avenue Denfert-Rochereau, 75014 Paris, France; martin.chalumeau{at}wanadoo.fr

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 (0 and 5) to predict respectively, all-grade or grade 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 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.

Abbreviations: CRP, C reactive protein; UTI, urinary tract infection; VCUG, voiding cystourethrogram; VUR, vesicoureteral reflux

Keywords: epidemiology; urinary tract infection; validation studies; vesicoureteral reflux

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