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Validation of a decision rule identifying febrile young girls at high risk for urinary tract infection.
Pediatr Emerg Care. 2003 Jun; 19(3):162-4.PE

Abstract

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.

Authors+Show Affiliations

Section of Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA. mgorelic@mcw.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.
Validation Study

Language

eng

PubMed ID

12813300

Citation

Gorelick, Marc H., et al. "Validation of a Decision Rule Identifying Febrile Young Girls at High Risk for Urinary Tract Infection." Pediatric Emergency Care, vol. 19, no. 3, 2003, pp. 162-4.
Gorelick MH, Hoberman A, Kearney D, et al. Validation of a decision rule identifying febrile young girls at high risk for urinary tract infection. Pediatr Emerg Care. 2003;19(3):162-4.
Gorelick, M. H., Hoberman, A., Kearney, D., Wald, E., & Shaw, K. N. (2003). Validation of a decision rule identifying febrile young girls at high risk for urinary tract infection. Pediatric Emergency Care, 19(3), 162-4.
Gorelick MH, et al. Validation of a Decision Rule Identifying Febrile Young Girls at High Risk for Urinary Tract Infection. Pediatr Emerg Care. 2003;19(3):162-4. PubMed PMID: 12813300.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Validation of a decision rule identifying febrile young girls at high risk for urinary tract infection. AU - Gorelick,Marc H, AU - Hoberman,Alejandro, AU - Kearney,Diana, AU - Wald,Ellen, AU - Shaw,Kathy N, PY - 2003/6/19/pubmed PY - 2004/5/21/medline PY - 2003/6/19/entrez SP - 162 EP - 4 JF - Pediatric emergency care JO - Pediatr Emerg Care VL - 19 IS - 3 N2 - 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. SN - 1535-1815 UR - https://www.unboundmedicine.com/medline/citation/12813300/Validation_of_a_decision_rule_identifying_febrile_young_girls_at_high_risk_for_urinary_tract_infection_ L2 - https://doi.org/10.1097/01.pec.0000081238.98249.40 DB - PRIME DP - Unbound Medicine ER -