Validation of a decision rule identifying febrile young girls at high risk for urinary tract infection

Title

Validation of a decision rule identifying febrile young girls at high risk for urinary tract infection

Creator

Gorelick MH; Hoberman A; Kearney D; Wald E; Shaw KN

Publisher

Pediatric Emergency Care

Date

2003

Subject

Child; Female; Humans; Decision Support Techniques; Risk Factors; European Continental Ancestry Group; Sensitivity and Specificity; Hospitals; Case-Control Studies; Emergency Service; Preschool; P.H.S.; Research Support; U.S. Gov't; infant; retrospective studies; Pediatric/statistics & numerical data; Pennsylvania/epidemiology; ROC Curve; Area Under Curve; Bacteriuria/diagnosis/microbiology; Colony Count; False Positive Reactions; Fever/etiology; Hospital/statistics & numerical data; Microbial; Urinary Tract Infections/diagnosis/epidemiology

Description

OBJECTIVE: To validate a previously published clinical decision rule to predict risk of urinary tract infection in febrile young girls. METHODS: We performed a retrospective case-control study at a children's hospital emergency department in a different city than that in which the original derivation study took place. Girls younger than 2 years in whom urinalysis and urine culture were performed for evaluation of fever were eligible. Cases consisted of all patients with a positive urine culture result, defined as 50,000 or more colony-forming units per milliliter of a urinary tract pathogen (n = 98). A random sample of patients with a negative urine culture result (n = 114) was also selected as controls. The clinical prediction rule included five risk factors: age younger than 12 months, white race, temperature of 39.0 degrees C or higher, absence of any other potential source of fever, and fever for 2 days or more. The sensitivity and false-positive rate of this rule were calculated at different cutoff values. RESULTS: The overall discriminative ability of the rule, as indicated by the area under the receiver-operator characteristic curve (AUC), was similar in this validation sample (AUC = 0.72) to that in the original study (AUC = 0.76). However, in the validation sample, the presence of three or more risk factors (rather than two or more as in the original study) appeared to be the optimum cutoff to define a positive rule, which results in an indication for obtaining further diagnostic testing (sensitivity, 88% [95% CI, 79-94%]; false-positive rate, 70% [95% CI, 61-79%]). CONCLUSION: A simple clinical decision rule previously developed to predict urinary tract infection based on five risk factors performs similarly in a different patient population.
2003

Rights

Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).

Type

Journal Article

Citation List Month

Backlog

Pages

162-164

Issue

3

Volume

19

Citation

Gorelick MH; Hoberman A; Kearney D; Wald E; Shaw KN, “Validation of a decision rule identifying febrile young girls at high risk for urinary tract infection,” Pediatric Palliative Care Library, accessed October 20, 2021, https://pedpalascnetlibrary.omeka.net/items/show/12798.

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