Urinary Tract Infection Research Today is a free monthly online journal that collates and summarizes the latest research about Urinary Tract Infection, including details on uti, causes, prevention, diet, treatment.

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

Leroy S, Marc E, Adamsbaum C, Gendrel D, Bréart G, Chalumeau M

Clinical Epidemiology Unit, Department of Paediatrics, Saint-Vincent-de-Paul Hospital, AP-HP, Université Paris V, Paris, France.

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

Published 22 February 2006 in Arch Dis Child, 91(3): 241-4.
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