RT Journal Article
SR Electronic
T1 Clinical prediction rules for childhood UTIs: a cross-sectional study in ambulatory care
JF BJGP Open
JO BJGP Open
FD Royal College of General Practitioners
SP BJGPO.2021.0171
DO 10.3399/BJGPO.2021.0171
A1 Hanne Ann Boon
A1 Jan Y Verbakel
A1 Tine De Burghgraeve
A1 Ann Van den Bruel
YR 2022
UL http://bjgpopen.org/content/early/2022/01/12/BJGPO.2021.0171.abstract
AB 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.