Journal Club Summary

Methodology Score: 3.5/5
Usefulness Score: 3/5

Shaikh N, Hoberman A, Hum SW, Alberty A, Muniz G, Kurs-Lasky M, Landsittel D, Shope T. JAMA Pediatr. 2018 Jun 1;172(6):550-556.

Question and Methods: The objective was to develop a risk-tool (UTICalc) to aid physicians in deciding when to perform urinanalysis and when to empirically treat febrile children 2 to 23 months of age. Single center study. Retrospective nested case control for derivation and a temporal validation cohort

Findings: Models that included lab parameters (dipstick, gram’s stain etc.) performed better. When validated on hypothetical cohort of 1000 febrile patients (70 with assumed UTI), UTICalc when compared to AAP algorithm reduced testing by 8.1% (95% CI 4.2%-12.0%) and reduced the number of treatment delays by 10.6% (95% CI, 0.9%-20.4%)

Limitations: Retrospective, not prospectively or externally validated, single center, inter-rater reliability of the variables not reported.

Interpretation: Potentially practice changing once externally and prospectively validated

By: Dr. Richard Hoang

 

Epi Lesson

Nested Case Control Study

In case control study two groups of patients one with the outcome (cases) and the other without the outcome of interest (controls) are studied to identify the factors that contributed to the outcome. Controls can be anyone who is at risk for the outcome but did not develop the outcome. Nested case control study is a modification to the above study design where both the cases and controls are derived (nested) within a larger well-defined cohort.

By: Dr. Venkatesh Thiruganasambandamoorthy

Hans Rosenberg
Dr. Rosenberg is an emergency physician at the Ottawa Hospital, assistant professor at the University of Ottawa, and Director of the Digital Scholarship and Knowledge Dissemination Program.