NEW YORK (Reuters Health) – In a pediatric UTI risk prediction model, replacing race with UTI history and fever duration yielded similar accuracy, researchers say.
“Race-conscious medicine encourages investigating how race is likely to be a proxy for other factors that should instead be used for risk prediction,” write Dr. Nader Shaikh of the Children’s Hospital of Pittsburgh of UPMC and colleagues write in JAMA Pediatrics.
Echoing the paper, Dr. Shaikh told Reuters Health by email, “Although previous studies suggested that an association between race and UTI exists, because of the issues associated with the inclusion of race in decision models, we replaced the variable of race with history of UTI and duration of fever in a previously developed risk prediction model and found similar accuracy.”
Dr. Saikh and colleagues reviewed the literature through May 2021 to assess whether other variables could replace race in a previously developed prediction tool without adversely affecting its accuracy.
The main outcome was the odds of UTI among non-Black children versus Black children.
Sixteen studies with close to 18,000 children were included. In the primary analysis, which included 11 studies, the pooled odds ratio of UTI among non-Black children was 2.44-fold higher than among Black children. The corresponding odds ratio in studies with low or very low risk of bias was 4.84-fold higher among non-Black children compared with Black children.
Replacing race with history of UTI and fever duration resulted in a model with similar accuracy. In the training cohort, the model had an overall sensitivity of 96%; overall specificity, 35%; and overall area under the receiver operating characteristic curve, 0.80.
Corresponding values for the validation cohort were overall sensitivity, 97%; overall specificity, 32%; and overall area under the receiver operating characteristic curve, 0.84.
Dr. Craig Peters, Vice Chair of Urology at UT Southwestern Medical Center and Chief of Pediatric Urology at Children’s Medical Center Dallas, commented on the study in an email to Reuters Health.
“The utility of race-based criteria is becoming viewed with concern, as it may mask certain non-medical issues, such as implicit bias and socioeconomic variation,” he said. “This evolution is also in the context of shifting perspectives on the importance of detecting UTI in children.”
The authors state that race can be replaced by fever duration and a history of prior UTI, he noted. “This seems very reasonable; however, I am concerned that the accuracy of that prior history may be limited,” Dr. Peters said. “It has been my experience in many cases that children are labeled as having a UTI when in fact they do not, because the proper diagnostic steps have not been followed.”
“I agree with the general change in approach, however, for the very simple reason that race is not only a social construct, but it cannot be strictly defined,” he said. “In the U.S., there has been a significant admixture of races for generations, and a Black versus not-Black distinction is difficult to justify.”
“Therefore, it is probably prudent to use a predictive tool uniformly in children if it performs well. While this may lead to some unnecessary bladder catheterizations, it reduces the risk of missing a potentially harmful urinary infection and the sequelae of that infection,” Dr. Peters concluded.
SOURCE: https://bit.ly/3rZrVUy and https://bit.ly/3xYTph3 JAMA Pediatrics, online April 18, 2022.
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