Oostenbrink et al developed a score for identifying vesicoureteral reflux (VUR) in a young child presenting with a first urinary tract infection. The authors are from Sophia Children's Hospital, Juliana Children's Hospital, Univeristy of Rotterdam, University of Leiden and University of Utrecht in The Netherlands.
Patient selection: pediatric patient from 0 to 5 years of age with a urinary tract infection
Parameters:
(1) age of the patient
(2) gender
(3) family history of vesicoureteral reflux in a first-degree relative
(4) C-reactive protein (CRP) in mg/L
(5) renal pelvic dilatation on renal ultrasound
|
Parameter |
Finding |
Points |
|
age of the patient in years |
< 1 year |
0 |
|
|
1 to 1.99 years |
1 |
|
|
2 to 2.99 years |
2 |
|
|
3 to 3.99 years |
3 |
|
|
4 to 4.99 |
4 |
|
|
5 to 5.99 |
5 |
|
gender |
female |
0 |
|
|
male |
1 |
|
family history |
no |
0 |
|
|
yes |
1 |
|
CRP |
|
MIN(20,INT(CRP/10)+1) |
|
renal pelvis dilatation |
none |
0 |
|
|
present |
1 |
where:
• The radiologist graded the renal ultrasound as Grade 0 if no dilatation, Grade 1 if pyelectasis present, Grade 2 for mild dilatation and Grade 3 for severe dilatation.
• There are 2 possible ways to use the renal pelvis dilatation in the score. The method above assumes that it is present or absent. The alternative approach is to use the grade assigned by the radiologist. The latter approach could result in very large numbers that do not seem to match the data shown in Table 3 of Oostenbrink et al.
score =
= (6 * (points for gender)) + (7 * (points for family history)) - (points for age) + (points for CRP) + (14 * (points for renal pelvis dilatation)
Interpretation:
• minimum score: < 0
• maximum score: > 25
• The higher the score the more likely that the patient has vesicoureteral reflux.
|
Total Score |
Any Grade of VUR |
Grade 3+ VUR |
|
<= 0 |
0 |
0% |
|
1 to 5 |
12% |
0% |
|
6 to 10 |
21% |
16% |
|
11 to 15 |
23% |
19% |
|
16 to 25 |
19% |
15% |
|
> 25 |
70% |
59% |
Performance:
• The score is sensitive but not specific.
• The score is heavily weighted for the CRP which can be elevated in many inflammatory conditions.
Specialty: Nephrology, Clinical Laboratory
ICD-10: ,
