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
- urinary tract infection
- validation studies
- vesicoureteral reflux
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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