The Diagnosis of Urinary Tract infection in Young children (DUTY): a diagnostic prospective observational study to derive and validate a clinical algorithm for the diagnosis of urinary tract infection in children presenting to primary care with an acute illness

摘要: Background: It is not clear which young children presenting acutely unwell to primary care should be investigated for urinary tract infection (UTI) and whether or dipstick testing used inform antibiotic treatment. Objectives: To develop algorithms accurately identify pre-school in whom urine obtained; assess urinalysis provides additional diagnostic information; model algorithm cost-effectiveness. Design: Multicentre, prospective cohort study. Setting participants: Children Methods: One hundred seven clinical characteristics (index tests) were recorded from the child’s past medical history, symptoms, physical examination signs test. Prior results clinician opinion of UTI likelihood (‘clinical diagnosis’) sampling treatment intentions judgement’) recorded. All index tests measured blind reference standard, defined as a pure predominant uropathogen cultured at ? 105 colony-forming units (CFU)/ml single research laboratory. Urine was collected by clean catch (preferred) nappy pad. Index sequentially evaluated two groups, stratified collection method: parent-reported symptoms with clinician-reported signs, results. Diagnostic accuracy quantified using area under receiver operating characteristic curve (AUROC) 95% confidence interval (CI) bootstrap-validated AUROC, compared ‘clinician diagnosis’ AUROC. Decision-analytic models optimal strategy ‘clinical judgement’. Results: A total 7163 recruited, 50% female 49% ‘Clinical correctly identified 13.3% positive cultures, 98.5% specificity an AUROC 0.63 (95% CI 0.53 0.72). Four independently associated UTI, 0.81 (0.72 0.90; validated 0.78) increasing 0.87 (0.80 0.94; 0.82) findings. high threshold clean-catch more accurate less costly than, effective as, judgement. The utility offset its costs. cost-effectiveness pad clear-cut. Conclusions: Clinicians prioritise use can cost-effectively improve identification where possible. Dipstick targeting treatment, but higher cost than waiting laboratory result. Future needed distinguish pathogens contaminants, impact on patient outcomes, presumptive versus laboratory-guided Funding: National Institute Health Research Technology Assessment programme.