Predictive score for vesicoureteral reflux in children with a first febrile urinary tract infection.

Abstract

To develop a simple score for predicting vesicoureteral reflux after a first febrile urinary tract infection in children. A retrospective cohort study was conducted for a 12-year period (January 2008 to December 2019), including patients aged <72months who underwent renal ultrasonography and voiding cystourethrography after a first febrile urinary tract infection. Patients with a history of antenatal hydronephrosis were excluded. The prediction model and score for vesicoureteral reflux were developed using multivariate logistic regression analysis. Out of 260 patients in total (median age 4months, 172 boys), 41 (16%) had vesicoureteral reflux. The score was based on four independent risk factors, including age >6months (odds ratio 2.71, 95% confidence interval 1.27-5.76), presence of sepsis (odds ratio 3.44, 95% confidence interval 1.31-9.04), white blood cell count ≥15000/mm3 (odds ratio1.83, 95% confidence interval 0.88-3.8) and abnormal renal ultrasonography results (odds ratio2.08, 95% confidence interval 1-4.31). A lower probability of vesicoureteral reflux (positive likelihood ratio=0.66; P=0.001) was found in the low-risk group (scores 0-2), whereas a higher probability of vesicoureteral reflux (positive likelihood ratio=2.54; P=0.001) was found in the high-risk group (scores 3-5). The predictive ability of the model was 70%. The scores developed based on the patient characteristics and renal ultrasonography are useful in predicting presence of vesicoureteral reflux after a first febrile urinary tract infection in children and could guide clinicians' decisions to perform additional imaging studies.