TY - JOUR T1 - Clinical prediction rules for childhood UTIs: a cross-sectional study in ambulatory care JF - BJGP Open JO - BJGP Open DO - 10.3399/BJGPO.2021.0171 SP - BJGPO.2021.0171 AU - Hanne Ann Boon AU - Jan Y Verbakel AU - Tine De Burghgraeve AU - Ann Van den Bruel Y1 - 2022/01/12 UR - http://bjgpopen.org/content/early/2022/01/12/BJGPO.2021.0171.abstract N2 - Background Diagnosing childhood urinary tract infections (UTI) is challenging.Aim Validate clinical prediction rules (UTIcalc, DUTY, Gorelick) for paediatric UTIs in primary care.Design & setting Post-hoc analysis of a cross-sectional study in 39 general practices and 2 emergency departments (Belgium, March 2019 to March 2020).Method Physicians recruited acutely ill children ≤18 years and sampled urine systematically for culture. Per rule, we performed an apparent validation; calculated sensitivities and specificities with 95%CI per threshold in the target group. For the DUTY coefficient-based algorithm, we performed a logistic calibration and calculated the Area Under the Curve with 95%CI.Results Of 834 children ≤18 years recruited, there were 297 children <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%. In contrast, the DUTY score ≥5 points had low sensitivity (8%), but high specificity (99%). Urine samples would be obtained in 72% vs 38% (UTIcalc), 92% vs 38% (Gorelick) or 1% vs 32% (DUTY) of children, compared to routine care. The number of missed infections per score was 1/4 (UTIcalc), 2/23 (Gorelick) and 24/26 (DUTY). The UTIcalc+ dipstick model had high sensitivity and specificity (100%; and 91%); resulting in no missed cases and 59% (95%CI 49%–68%) of antibiotics prescribed inappropriately.Conclusion In this study, the UTIcalc and Gorelick score were useful for ruling out UTI but resulted in high urine sampling rates. The DUTY score had low sensitivity, meaning that 92% of UTIs would be missed. ER -