Leroy, SandrineBouissou, FrançoisFernández López, AnnaGurgoze, Metin K.Karavanaki, KyriakiUlinski, TimBressan, SilviaVaos, GeogiosLeblond, PierreCoulais, YvonLuaces Cubells, CarlesAygun, A. DenizmenStefanidis, Constantinos J.Bensman, AlbertDaDalt, LivianaGardikis, StefanosBigot, SandraGendrel, DominiqueBréart, GérardChalumeau, Martin2021-03-172021-03-172011-12-281932-6203https://hdl.handle.net/2445/175204Background: Predicting vesico-ureteral reflux (VUR) ≥3 at the time of the first urinary tract infection (UTI) would make it possible to restrict cystography to high-risk children. We previously derived the following clinical decision rule for that purpose: cystography should be performed in cases with ureteral dilation and a serum procalcitonin level ≥0.17 ng/mL, or without ureteral dilatation when the serum procalcitonin level ≥0.63 ng/mL. The rule yielded a 86% sensitivity with a 46% specificity. We aimed to test its reproducibility. Study design: A secondary analysis of prospective series of children with a first UTI. The rule was applied, and predictive ability was calculated. Results: The study included 413 patients (157 boys, VUR ≥3 in 11%) from eight centers in five countries. The rule offered a 46% specificity (95% CI, 41-52), not different from the one in the derivation study. However, the sensitivity significantly decreased to 64% (95%CI, 50-76), leading to a difference of 20% (95%CI, 17-36). In all, 16 (34%) patients among the 47 with VUR ≥3 were misdiagnosed by the rule. This lack of reproducibility might result primarily from a difference between derivation and validation populations regarding inflammatory parameters (CRP, PCT); the validation set samples may have been collected earlier than for the derivation one. Conclusions: The rule built to predict VUR ≥3 had a stable specificity (ie. 46%), but a decreased sensitivity (ie. 64%) because of the time variability of PCT measurement. Some refinement may be warranted.7 p.application/pdfengcc-by (c) Leroy, Sandrine et al., 2011http://creativecommons.org/licenses/by/3.0/esInfeccions del tracte urinariPediatriaUrinary tract infectionsPediatricsinfo:eu-repo/semantics/article6927992021-03-17info:eu-repo/semantics/openAccess22216314