UTICalc demonstrated strong diagnostic performance for UTI in febrile children aged 2 to 24 months, supporting its use as an evidence-based adjunct in emergency department patient assessment.
This multicenter diagnostic study prospectively provides the final stage of external validation for UTICalc in young febrile children. We found strong discrimination for the model, which was improved when incorporating dipstick data. This study supports integration into clinical care as a tool for diagnostic stewardship in pediatric care.
Decision curve analysis supported the utility of both UTICalc models across relevant thresholds. However, clinician judgment demonstrated higher sensitivity in the high-volume tertiary centers where this study was conducted, reflecting pediatric emergency medicine practitioner expertise. Because most children presenting for acute care are evaluated outside tertiary centers,27 possibly with limited pediatric expertise and uncertain follow-up, using a 5% risk threshold—despite reducing testing—may not be ideal due to reduced sensitivity. UTICalc may serve as a useful adjunct for clinicians with less pediatric experience or in cases of diagnostic uncertainty, with lower risk thresholds (eg, 2%) potentially more appropriate for patients with persistent symptoms or anticipated barriers to follow-up.
The observed UTI prevalence of 4% in our cohort is consistent with previously reported risk estimates in this population, which ranges from 3% to 11%.2,28,29 Model performance in our study was comparable with the original derivation and validation study published in 2018, which reported an AUROC of 0.80 in the clinical model and 0.97 in the clinical and dipstick model. Low PPV in our sample is reflective of low disease prevalence.