Journal Article

Predicting the Need for Radiologic Imaging in Adults with Febrile Urinary Tract Infection

C. van Nieuwkoop, B. P. C. Hoppe, T. N. Bonten, J. W. van't Wout, N. J. M. Aarts, B. J. Mertens, E. M. S. Leyten, T. Koster, G. H. Wattel-Louis, N. M. Delfos, H. C. Ablij, H. W. Elzevier and J. T. van Dissel

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 51, issue 11, pages 1266-1272
Published in print December 2010 | ISSN: 1058-4838
Published online December 2010 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/657071
Predicting the Need for Radiologic Imaging in Adults with Febrile Urinary Tract Infection

More Like This

Show all results sharing these subjects:

  • Infectious Diseases
  • Immunology
  • Public Health and Epidemiology
  • Microbiology

GO

Show Summary Details

Preview

Background. Radiologic evaluation of adults with febrile urinary tract infection (UTI) is frequently performed to exclude urological disorders. This study aims to develop a clinical rule predicting need for radiologic imaging.

Methods. We conducted a prospective, observational study including consecutive adults with febrile UTI at 8 emergency departments (EDs) in the Netherlands. Outcomes of ultrasounds and computed tomographs of the urinary tract were classified as “urgent urological disorder” (pyonephrosis or abscess), “nonurgent urologic disorder,” “normal,” and “incidental nonurological findings.” Urgent and nonurgent urologic disorders were classified as “clinically relevant radiologic findings.” The data of 5 EDs were used as the derivation cohort, and 3 EDs served as the validation cohort.

Results. Three hundred forty-six patients were included in the derivation cohort. Radiologic imaging was performed for 245 patients (71%). A prediction rule was derived, being the presence of a history of urolithiasis, a urine pH ≥7.0, and/or renal insufficiency (estimated glomerular filtration rate, ≤40 mL/min/1.73 m3). This rule predicts clinically relevant radiologic findings with a negative predictive value (NPV) of 93% and positive predictive value (PPV) of 24% and urgent urological disorders with an NPV of 99% and a PPV of 10%. In the validation cohort (n = 131), the NPV and PPV for clinically relevant radiologic findings were 89% and 20%, respectively; for urgent urological disorders, the values were 100% and 11%, respectively. Potential reduction of radiologic imaging by implementing the prediction rule was 40%.

Conclusions. Radiologic imaging can selectively be applied in adults with febrile UTI without loss of clinically relevant information by using a simple clinical prediction rule.

Journal Article.  4053 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

Full text: subscription required

How to subscribe Recommend to my Librarian

Users without a subscription are not able to see the full content. Please, subscribe or login to access all content.