Departments of Paediatrics, Oulu University Hospital, Oulu and Central Hospital of Central Finland, Jyväskylä, Finland.
J Urol. 2010 Jul;184(1):325-8. doi: 10.1016/j.juro.2010.02.002. Epub 2010 May 20.
Urinary tract infection is common in children and may be associated with significant urinary tract pathology. Many children are investigated for vesicoureteral reflux after the first urinary tract infection but less than a quarter have reflux. Imaging with voiding cystourethrogram is not without risk. An approach was proposed to predict reflux in children with a urinary tract infection. We sought to validate a preestablished clinical decision rule to target voiding cystourethrogram more efficiently in children after the first urinary tract infection.
We tested the usefulness of a clinical decision rule to predict vesicoureteral reflux in 406 consecutive children younger than 5 years who were treated or referred for consultation due to an acute urinary tract infection. Symptoms and signs of urinary tract infection and imaging findings were analyzed.
Vesicoureteral reflux was found in 120 children (35%), including 69 (20%) with grade III-V reflux. An abnormal ultrasound finding was seen in 71 cases (18%) but was not associated with reflux. The clinical decision rule appeared to have poor sensitivity of only 24% to identify grade III-V reflux. We found it impractical to predict vesicoureteral reflux in children with a urinary tract infection.
Results show that it is not possible to predict grade III-V vesicoureteral reflux reliably using the clinical decision rule. The recent guidelines recommending a search for reflux after a urinary tract infection in children cannot be revised using this decision rule.
尿路感染在儿童中很常见，可能与严重的尿路病变有关。许多儿童在首次尿路感染后会进行膀胱输尿管反流检查，但只有不到四分之一的儿童有反流。使用排尿性膀胱尿道造影进行影像学检查并非没有风险。有人提出了一种方法来预测尿路感染儿童的反流情况。我们试图验证一种预先确定的临床决策规则，以更有效地针对首次尿路感染后儿童进行排尿性膀胱尿道造影。
我们测试了一种临床决策规则在 406 例连续就诊的年龄小于 5 岁的急性尿路感染儿童中的有效性，这些儿童因急性尿路感染而接受治疗或转诊咨询。分析了尿路感染的症状和体征以及影像学表现。
120 例儿童（35%）发现有膀胱输尿管反流，其中 69 例（20%）为 3 级-5 级反流。71 例（18%）有异常超声表现，但与反流无关。临床决策规则的敏感性似乎很差，仅为 24%，无法识别 3 级-5 级反流。我们发现，预测尿路感染儿童的膀胱输尿管反流是不切实际的。
结果表明，使用临床决策规则无法可靠地预测 3 级-5 级膀胱输尿管反流。最近的指南建议在儿童尿路感染后寻找反流，但不能使用该决策规则进行修订。
