Clinical prediction rules for childhood urinary tract infections: a cross-sectional study in ambulatory care
Abstract
BACKGROUND: Diagnosing childhood urinary tract infections (UTIs) is challenging. Clinical prediction rules may help to identify children that require urine sampling. However, there is a lack of research to determine the accuracy of the scores in general practice.
AIM: To validate clinical prediction rules (UTI Calculator [UTICalc], A Diagnosis of Urinary Tract Infection in Young Children [DUTY], and Gorelick score) for paediatric UTIs in primary care.
DESIGN & SETTING: Post-hoc analysis of a cross-sectional study in 39 general practices and two emergency departments (EDs). The study took place in Belgium from March 2019-March 2020.
METHOD: Physicians recruited acutely ill children aged ≤18 years and sampled urine systematically for culture. Per rule, an apparent validation was performed, and sensitivities and specificities were calculated with 95% confidence intervals (CIs) per threshold in the target group. For the DUTY coefficient-based algorithm, a logistic calibration was performed and the area under the receiver operating characteristic curve (AUC) was calculated with 95% CI.
RESULTS: Of 834 children aged ≤18 years recruited, there were 297 children aged <5 years. The UTICalc and Gorelick score had high-to-moderate sensitivity and low specificity: UTICalc (≥2%) 75% and 16%, respectively; Gorelick (≥2 variables) 91% and 8%, respectively. In contrast, the DUTY score ≥5 points had low sensitivity (8%) but high specificity (99%). Urine samples would be obtained in 72%…
How strong is the evidence?
Evidence Hub reads this as a cross-sectional, done in people. Its evidence level is 4 of 5 (Low · observational). Observational designs can show an association but not prove cause. Reported size: 834 participants or records.
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