Article Text

PDF
Prediction of vesicoureteral reflux after a first febrile urinary tract infection in children: validation of a clinical decision rule
  1. S Leroy1,
  2. E Marc2,
  3. C Adamsbaum3,
  4. D Gendrel1,
  5. G Bréart4,
  6. M Chalumeau4
  1. 1Clinical Epidemiology Unit, Department of Paediatrics, Saint-Vincent-de-Paul Hospital, AP-HP, Université Paris V, Paris, France
  2. 2Department of Emergency Medicine, Saint-Vincent-de-Paul Hospital, AP-HP, Université Paris V, Paris, France
  3. 3Department of Radiology, Saint-Vincent-de-Paul Hospital, AP-HP, Université Paris V, Paris, France
  4. 4INSERM U149, Paris, France
  1. 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

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 (⩽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.

  • CRP, C reactive protein
  • UTI, urinary tract infection
  • VCUG, voiding cystourethrogram
  • VUR, vesicoureteral reflux
  • epidemiology
  • urinary tract infection
  • validation studies
  • vesicoureteral reflux

Statistics from Altmetric.com

Footnotes

  • Published Online First 12 May 2005

  • Funding: S Leroy was financially supported by a grant from the Association des Juniors en Pédiatrie and Laboratoire Gallia

  • Competing interests: none declared

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles