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Predictive score for vesicoureteral reflux in children with a first febrile urinary tract infection
Kanita Lertdumrongluk1, Paungpaga Lertdumrongluk2
1Department of Paediatrics, Charoenkrung Pracharak Hospital, Bangkok Metropolitan Administration, Bangkok, Thailand.
Insights
A new score helps predict vesicoureteral reflux in children after a febrile urinary tract infection. This tool aids clinicians in deciding whether further imaging is necessary, improving diagnostic accuracy.
Area of Science:
- Pediatric Nephrology
- Diagnostic Imaging
- Urology
Background:
- Febrile urinary tract infections (UTIs) are common in children.
- Vesicoureteral reflux (VUR) is a significant risk factor for recurrent UTIs and renal scarring.
- Accurate prediction of VUR is crucial for appropriate management and preventing long-term complications.
Purpose of the Study:
- To develop and validate a simple clinical score for predicting the presence of vesicoureteral reflux (VUR) in children.
- To identify key risk factors associated with VUR after a first febrile UTI.
- To provide a tool to guide the decision-making process for further imaging.
Main Methods:
- A retrospective cohort study included 260 children under 72 months with a first febrile UTI.
- Patients underwent renal ultrasonography and voiding cystourethrography.
- Multivariate logistic regression analysis was used to develop a prediction score based on independent risk factors.
Main Results:
- Vesicoureteral reflux (VUR) was present in 16% of the cohort (41 out of 260 patients).
- The prediction score incorporated age >6 months, sepsis, elevated white blood cell count (≥15,000/mm³), and abnormal renal ultrasonography.
- The model demonstrated a 70% predictive ability, with distinct probabilities of VUR in low-risk (scores 0-2) and high-risk (scores 3-5) groups.
Conclusions:
- The developed score effectively predicts VUR in children following a first febrile UTI.
- The score can assist clinicians in determining the need for additional imaging studies.
- This tool has the potential to optimize diagnostic pathways and resource utilization in pediatric urology.
Objective:
To develop a simple score for predicting vesicoureteral reflux after a first febrile urinary tract infection in children.
Methods:
A retrospective cohort study was conducted for a 12-year period (January 2008 to December 2019), including patients aged <72 months who underwent renal ultrasonography and voiding cystourethrography after a first febrile urinary tract infection. Patients with a history of antenatal hydronephrosis were excluded. The prediction model and score for vesicoureteral reflux were developed using multivariate logistic regression analysis.
Results:
Out of 260 patients in total (median age 4 months, 172 boys), 41 (16%) had vesicoureteral reflux. The score was based on four independent risk factors, including age >6 months (odds ratio 2.71, 95% confidence interval 1.27-5.76), presence of sepsis (odds ratio 3.44, 95% confidence interval 1.31-9.04), white blood cell count ≥15 000/mm3 (odds ratio 1.83, 95% confidence interval 0.88-3.8) and abnormal renal ultrasonography results (odds ratio 2.08, 95% confidence interval 1-4.31). A lower probability of vesicoureteral reflux (positive likelihood ratio = 0.66; P = 0.001) was found in the low-risk group (scores 0-2), whereas a higher probability of vesicoureteral reflux (positive likelihood ratio = 2.54; P = 0.001) was found in the high-risk group (scores 3-5). The predictive ability of the model was 70%.
Conclusions:
The scores developed based on the patient characteristics and renal ultrasonography are useful in predicting presence of vesicoureteral reflux after a first febrile urinary tract infection in children and could guide clinicians' decisions to perform additional imaging studies.
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