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

Sandrine Leroy ¹, Elisabeth Marc ², Catherine Adamsbaum ³, Dominique Gendrel ¹, Gérard Bréart ⁴ and Martin Chalumeau ^5*

¹ Clinical Epidemiology Unit, Department of Pediatrics, Saint-Vincent-de-Paul Hospital, AP-HP, Paris, France
² Department of Emergency Medicine, Saint-Vincent-de-Paul Hospital, AP-HP, Paris, France
³ Department of Radiology, Saint-Vincent-de-Paul Hospital, AP-HP, Paris, France
⁴ INSERM U149, Paris, France
⁵ Clinical Epidemiology Unit, Saint-Vincent-de-Paul Hospital, AP-HP and INSERM U149, Paris, France

^* To whom correspondence should be addressed. E-mail: martin.chalumeau{at}wanadoo.fr.

Accepted 9 May 2005

Abstract

Background:Among the many clinical decision rules which are proposed to take in charge day to day dilemmas facing the practising pediatricians, few are validated.

Objective:To test the reproducibility of a highly sensitive clinical decision rule previously proposed to predict vesicoureteral reflux (VUR) after a first febrile urinary tract infection in children. This rule combined clinical (family history of uropathology, male gender, young age), biological (elevated C-reactive protein) and radiological (urinary tract dilatation on renal ultrasound) predictors in a score, and provided a 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:149 children were included. VUR prevalence was 25%. The rule yielded 100% sensitivity and 3% specificity for all-grade VUR, and 93% sensitivity and a 13% specificity for grade 3 VUR. Some methodological weaknesses (variables selection and cotation) 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.

Keywords: epidemiology, urinary tract infections, validation studies, vesicoureteral reflux

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