Related Experiment Video
Updated: Oct 6, 2025
Establishment and Characterization of UTI and CAUTI in a Mouse Model
Published on: June 23, 2015
Clinical prediction rules for childhood urinary tract infections: a cross-sectional study in ambulatory care
Hanne Ann Boon1, Jan Y Verbakel1,2, Tine De Burghgraeve1
1EPI-Centre, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
Insights
Diagnosing childhood urinary tract infections (UTIs) is challenging. The UTICalc and Gorelick scores help rule out UTIs but increase urine sampling, while the DUTY score misses most infections.
Area of Science:
- Pediatric infectious diseases
- Clinical diagnostics
- Primary care medicine
Background:
- Diagnosing urinary tract infections (UTIs) in children presents significant challenges in clinical practice.
- Clinical prediction rules offer a potential method for identifying pediatric patients who require urine sampling for UTI diagnosis.
- Current research lacks sufficient data on the accuracy of these prediction rules within general practice settings.
Purpose of the Study:
- To validate the accuracy of three clinical prediction rules—UTI Calculator (UTICalc), A Diagnosis of Urinary Tract Infection in Young Children (DUTY), and Gorelick score—for diagnosing pediatric UTIs in primary care.
- To compare the performance of these rules in identifying children needing urine culture.
- To assess the impact of rule-based urine sampling on antibiotic prescribing.
Main Methods:
- A post-hoc analysis was conducted on a cross-sectional study involving 39 general practices and two emergency departments in Belgium (March 2019-March 2020).
- Acutely ill children aged 18 years or younger had urine systematically sampled for culture.
- Sensitivities, specificities, and areas under the receiver operating characteristic curve (AUC) were calculated for each rule, with logistic calibration for the DUTY score.
Main Results:
- The UTICalc and Gorelick scores demonstrated moderate-to-high sensitivity but low specificity for UTI diagnosis.
- The DUTY score (≥5 points) showed low sensitivity (8%) but high specificity (99%), indicating a high rate of missed infections (92%).
- The UTICalc + dipstick model achieved 100% sensitivity and 91% specificity, preventing missed cases but leading to 59% inappropriate antibiotic prescriptions.
Conclusions:
- The UTICalc and Gorelick scores are useful for ruling out pediatric UTIs but lead to increased urine sampling rates.
- The DUTY score exhibited poor sensitivity, resulting in a substantial proportion of UTIs being missed in this primary care validation.
- Combined approaches, such as UTICalc with dipstick testing, show promise for accurate UTI diagnosis but require careful consideration of antibiotic stewardship.
Background:
Diagnosing childhood urinary tract infections (UTIs) is challenging. Clinical prediction rules may help to identify children that require urine sampling. However, there is a lack of research to determine the accuracy of the scores in general practice.
Aim:
To validate clinical prediction rules (UTI Calculator [UTICalc], A Diagnosis of Urinary Tract Infection in Young Children [DUTY], and Gorelick score) for paediatric UTIs in primary care.
Design & Setting:
Post-hoc analysis of a cross-sectional study in 39 general practices and two emergency departments (EDs). The study took place in Belgium from March 2019-March 2020.
Method:
Physicians recruited acutely ill children aged ≤18 years and sampled urine systematically for culture. Per rule, an apparent validation was performed, and sensitivities and specificities were calculated with 95% confidence intervals (CIs) per threshold in the target group. For the DUTY coefficient-based algorithm, a logistic calibration was performed and the area under the receiver operating characteristic curve (AUC) was calculated with 95% CI.
Results:
Of 834 children aged ≤18 years recruited, there were 297 children aged <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%, respectively. In contrast, the DUTY score ≥5 points had low sensitivity (8%) but high specificity (99%). Urine samples would be obtained in 72% versus 38% (UTICalc), 92% versus 38% (Gorelick) or 1% versus 32% (DUTY) of children, compared with 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% to 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.
Related Concept Videos
01:30Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care
01:17Urinary Tract Infection IV: Nursing Management
01:26Urine Studies II: Urine Culture and Sensitivity Test
01:26Urinary Tract Infection I: Introduction
01:25Urinary Tract Infection II: Pathophysiology
01:28Urinary Tract Calculi V: Nursing Management