The diagnosis of urinary tract infections in young children (DUTY): protocol for a diagnostic and prospective observational study to derive and validate a clinical algorithm for the diagnosis of UTI in children presenting to primary care with an acute illness
The diagnosis of urinary tract infections in young children (DUTY): protocol for a diagnostic and prospective observational study to derive and validate a clinical algorithm for the diagnosis of UTI in children presenting to primary care with an acute illness
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DOI：
10.1186/1471-2334-12-158
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发表时间：
2012-07-19
影响因子：
3.7
通讯作者：
Hay, Alastair D.
中科院分区：
文献类型：
--
作者：
Downing, Harriet;Thomas-Jones, Emma;Hay, Alastair D.
背景：尿路感染（UTI）在儿童中很常见，可导致严重疾病和反复发作的症状。然而，在初级保健中从幼儿中获得尿液样本具有挑战性，并且对于大量儿童来说不可行。关于症状，体征和尿分析对儿童UTI的预测价值的证据是迫切需要的，以帮助初级保健临床医生更好地识别应进行UTI调查的儿童。本文描述了诊断小儿尿路感染（DUTY）研究的方案。总体研究的目的是推导并验证一种成本效益的临床算法，用于诊断急性不适的儿童泌尿道感染。方法/设计：DUTY是一项多中心、诊断性和前瞻性观察性研究，旨在招募至少7,000名5岁以下的儿童，在初级保健中评估任何急性、非创伤性疾病，但通常>10（5）CFU/mL的一种，但不超过两种尿路病原体。我们将使用逻辑回归来确定与阳性尿培养结果最密切相关的临床预测因素（即人口统计学、病史、表现体征和症状以及尿试纸分析结果）。然后，我们将使用经济评估，比较候选人的预测rules.Discussion的成本效益：这项研究将提供新的，临床上重要的信息，儿童泌尿道感染的诊断功能和有效的预测规则的成本效益，以帮助初级保健临床医生提高效率，他们的诊断策略为UTI在幼儿。
Background: Urinary tract infection (UTI) is common in children, and may cause serious illness and recurrent symptoms. However, obtaining a urine sample from young children in primary care is challenging and not feasible for large numbers. Evidence regarding the predictive value of symptoms, signs and urinalysis for UTI in young children is urgently needed to help primary care clinicians better identify children who should be investigated for UTI. This paper describes the protocol for the Diagnosis of Urinary Tract infection in Young children (DUTY) study. The overall study aim is to derive and validate a cost-effective clinical algorithm for the diagnosis of UTI in children presenting to primary care acutely unwell.Methods/design: DUTY is a multicentre, diagnostic and prospective observational study aiming to recruit at least 7,000 children aged before their fifth birthday, being assessed in primary care for any acute, non-traumatic, illness of 10(3), but usually >10(5) CFU/mL of one, but no more than two uropathogens. We will use logistic regression to identify the clinical predictors (i.e. demographic, medical history, presenting signs and symptoms and urine dipstick analysis results) most strongly associated with a positive urine culture result. We will then use economic evaluation to compare the cost effectiveness of the candidate prediction rules.Discussion: This study will provide novel, clinically important information on the diagnostic features of childhood UTI and the cost effectiveness of a validated prediction rule, to help primary care clinicians improve the efficiency of their diagnostic strategy for UTI in young children.