A new calculator, UTICalc, developed to estimate the probability of urinary tract infection (UTI) in children by evaluating risk factors, was described in a paper published in Pediatrics.
The study investigators developed and tested the new calculator in order to accurately estimate the probability of UTI in febrile pre-verbal children, which is necessary in order to appropriately target testing and treatment.
Training and validation databases, comprising 1686 and 384 febrile children, respectively, age 2 to 23 months who were brought to the emergency department of Children’s Hospital of Pittsburgh, Pennsylvania, were used in 5 separate models. Culture-confirmed UTI was used as the main outcome and cutoffs for high and low risk were identified in each model. The models were then incorporated into UTICalc and the tool used to evaluate medical records.
The clinical model employed in UTICalc reduced testing by 8.1% (95%CI, 4.2%-12.0%) and decreased the number of UTIs that were missed from 3 to none compared with the existing algorithm of the American Academy of Pediatrics. The dipstick model in UTICalc would also have reduced the number of treatment delays by 10.6% (95%CI, 0.9%-20.4%) compared with treating all children with a leukocyte esterase test result of 1+ or higher.
The database used to train the models was a retrospective sample tested for UTI; therefore UTICalc will likely perform best in children with a reasonable pretest probability of UTI. Thus, physicians should not use UTICalc if UTI is not already suspected on clinical grounds. Also, the validation database comes from a single institution, and a true test of UTICalc would require “a quasi-experimental or randomized study in primary care clinics and emergency departments.”
The investigators concluded that the approach outlined in this study does have the potential to improve outcomes in children with UTIs by tailoring testing and treatment to the risk factors present in the individual child being tested.
Shaikh N, Hoberman A, Hum SW, et al. Development and validation of a calculator for estimating the probability of urinary tract infection in young febrile children [published online April 16 2018]. JAMA Pediatr. doi:10.1001/jamapediatrics.2018.0217