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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 (⩽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
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