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儿童尿路感染的UTICalc与没有种族的外部验证
Anna G Smith1, Anisha Kshetrapal2, Lindsay Boles3
1Department of Emergency Medicine, University of Illinois at Chicago College of Medicine, Chicago, IL; Division of Emergency Medicine, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital, Chicago, IL.
The Journal of pediatrics
|August 22, 2023
概括
从UTICalc工具中删除种族并没有影响其在发烧儿童中预测尿路感染 (UTI) 的准确性. 这种验证证实了该工具的有效性.
科学领域:
- 儿科急救医学 儿科急救医学
- 临床决策支持系统 临床决策支持系统
- 传染病流行病学 传染病流行病学
背景情况:
- UTICalc是广泛使用的临床决策支持工具,用于评估发烧儿童尿路感染 (UTI) 风险.
- 外部验证对于确保这些工具的通用性和可靠性至关重要.
- 关于将种族纳入临床算法的担忧要求对其对绩效的影响进行调查.
研究的目的:
- 在一个新的发烧儿童队列中对UTICalc工具进行外部验证.
- 为了比较UTICalc的性能,包括和不包括种族.
- 评估不同风险值对工具准确性的影响.
主要方法:
- 在2-24个月的发烧儿童中进行了一项回顾性,单中心的病例控制研究.
- 培养确认的尿路感染病例与对照病例相匹配:1:1.
- 使用UTICalc的原始版本 (包括比赛) 和修订版 (不包括比赛) 的风险门为2%至5%来评估UTICalc的性能.
主要成果:
- 两种UTICalc版本都表现出类似的性能,接收器操作员特征曲线 (AUROC) 下的面积为73.4% (版本1.0) 和73.8% (版本3.0).
- 在2%的风险值下,种族排除模型 (3.0版本) 显示了96.7%的灵敏度和25.0%的特异性.
- 除种族之外,黑人儿童的假阴性从83% (10/12) 降低到33% (2/6).
结论:
- UTICalc工具的性能与包括种族在内或不包括种族在内仍然可比.
- 从UTICalc中删除种族并没有对其诊断准确性产生负面影响.
- 该研究表明,种族不是UTICalc在预测该人口中尿路感染的有效性的一个必要因素.
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