Which biomarkers and predictions rules are useful for ruling out UTI in children? | |||||||
Population acutely ill children < 18 years of age | |||||||
Index test biomarkers or clinical prediction rules | |||||||
Reference standard urine culture (cystitis), DMSA scan (pyelonephritis) | |||||||
Target condition urinary tract infection (cystitis, pyelonephritis) | |||||||
Setting primary care, outpatient | |||||||
Positive likelihood ratio (LR+) | Negative likelihood ratio (LR-) | ||||||
> 10 = very large increase in probability | 0–0.1 = very large decrease in probability | ||||||
5–10 = large increase in probability | 0.1–0.2 = large decrease in probability | ||||||
2–5 = moderate increase in probability | 0.2–0.5 = moderate decrease in probability | ||||||
1–2 = slight increase in probability | 0.5–1 = slight decrease in probability | ||||||
Outcome | Biomarkers | Number of patients (Number of studies) | LR+ (95%CI) | LR- (95%CI) | AUC (95%CI) | Quality of the evidence (GRADE) | Comments |
Cystitis (positive urine culture) | N | 55,402 (26a) | 39 (21–73) | 0.61 (0.55–0.68) | 0.79 (0.63–0.91) | ⨁⨁⨁◯ due to indirectness | d |
LE | 65,204 (26b) | 0.94 (0.80–0.98) | ⨁⨁⨁◯ due to indirectness and risk of bias | d | |||
trace | 8 (6–14) | 0.13 (0.09–0.25) | |||||
+ | 13 (9–19) | 0.16 (0.11–0.31) | |||||
++ | 28 (15–114) | 0.24 (0.14–0.76) | |||||
+++ | 61 (26–994) | 0.35 (0.15–0.96) | |||||
N or LE | 25,238 (22a) | 9 (6–13) | 0.13 (0.10–0.18) | 0.93 (0.91–0.96) | ⨁⨁⨁◯ due to indirectness | d | |
N and LE | 38,070 (10a) | 115 (33–394) | 0.65 (0.62–0.68) | 0.51 (0.38–0.83) | ⨁⨁⨁◯ due to indirectness | d | |
Protein ≥trace | 665 (3a) | 3 (2–3) | 0.69 (0.56–0.83) | 0.70 (0.47–0.91) | ⨁◯◯◯ due to inconsistency, indirectness and imprecision | d | |
WBC ≥5/hpf (manual) | 21,763 (18b) | 6 (6–25) | 0.27 (0.22–0.69) | 0.90 (0.77–0.98) | ⨁⨁⨁◯ due to indirectness | d | |
WBC ≥10/μL (automatic) | 56,286 (9b) | 4 (2–6) | 0.13 (0.06–0.23) | 0.91 (0.58–0.98) | ⨁⨁⨁◯ due to indirectness | d | |
B ≥ 1/hpf | 2979 (6b) | 3 (2–8) | 0.11 (0.06–0.24) | 0.93 (0.25–1.00) | ⨁◯◯◯ due to risk of bias, indirectness and imprecision | d | |
Gram stain ≥1/hpf | 13,945 (12b) | 20 (14–34) | 0.10 (0.06–0.15) | 0.98 (0.92–0.99) | ⨁⨁⨁⨁ | d | |
CRP ≥10 mg/L | 13,729 (9b) | 2 (1–2) | 0.38 (0.24–0.77) | 0.75 (0.62–0.83) | ⨁⨁◯◯ due to inconsistency and indirectness | ||
PCT ≥0.25 ng/mL | 6585 (4b) | 2 (2–8) | 0.56 (0.24–0.69) | 0.71 (0.62–0.80) | ⨁⨁◯◯ due to risk of bias and indirectness | e | |
DUTY (+LE, N, Hb) ≥5 points | 2277 (1c) | 5 (5–6) | 0.22 (0.13–0.37) | / | ⨁⨁⨁◯ due to imprecision | ||
UTIcalc (+LE, N) | 229 (1c) | 18 (10–33) | 0.05 (0.01–0.26) | / | ⨁◯◯◯ due to indirectness and imprecision | f | |
Pyelonephritis (positive DMSA scan) | WBCc 12 to 20 × 103/μL | 209 (2c) | 1.62 to 3.57 | 0.35 to 0.83 | / | ⨁◯◯◯ due to serious indirectness and imprecision | g |
CRP ≥20 mg/L | 7179 (5c) | 1.32 to 2.74 | 0.10 to 0.37 | / | ⨁⨁◯◯ due to imprecision and indirectness | ||
PCT ≥2 ng/mL | 436 (5c) | 2.93 to 14.22 | 0.32 to 0.74 | / | ⨁◯◯◯ due to inconsistency, indirectness and imprecision | g |