Shaikh, N and Morone, NE and Lopez, J and Chianese, J and Sangvai, S and D'Amico, F and Hoberman, A and Wald, ER
(2007)
Does this child have a urinary tract infection?
JAMA - Journal of the American Medical Association, 298 (24).
2895 - 2904.
ISSN 0098-7484
![[img]](http://d-scholarship.pitt.edu/style/images/fileicons/text_plain.png) |
Plain Text (licence)
Available under License : See the attached license file.
Download (1kB)
|
Abstract
Context: Urinary tract infection (UTI) is a frequently occurring pediatric illness that, if left untreated, can lead to permanent renal injury. Accordingly, accurate diagnosis of UTI is important. Objective: To review the diagnostic accuracy of symptoms and signs for the diagnosis of UTI in infants and children. Data Sources: A search of MEDLINE and EMBASE databases was conducted for articles published between 1966 and October 2007, as well as a manual review of bibliographies of all articles meeting inclusion criteria, 1 previously published systematic review, 3 clinical skills textbooks, and 2 experts in the field, yielding 6988 potentially relevant articles. Study Selection: Studies were included if they contained data on signs or symptoms of UTI in children through age 18 years. Of 337 articles examined, 12 met all inclusion criteria. Data Extraction: Two evaluators independently reviewed, rated, and abstracted data from each article. Data Synthesis: In infants with fever, history of a previous UTI (likelihood ratio [LR] range, 2.3-2.9), temperature higher than 40°C (LR range, 3.2-3.3), and suprapubic tenderness (LR, 4.4; 95% confidence interval [CI], 1.6-12.4) were the findings most useful for identifying those with a UTI. Among male infants, lack of circumcision increased the likelihood of a UTI (summary LR, 2.8; 95% CI, 1.9-4.3); and the presence of circumcision was the only finding with an LR of less than 0.5 (summary LR, 0.33; 95% CI, 0.18-0.63). Combinations of findings were more useful than individual findings in identifying infants with a UTI (for temperature >39°C for >48 hours without another potential source for fever on examination, the LR for all findings present was 4.0; 95% CI, 1.2-13.0; and for temperature <39°C with another source for fever, the LR was 0.37; 95% CI, 0.16-0.85). In verbal children, abdominal pain (LR, 6.3; 95% CI, 2.5-16.0), back pain (LR, 3.6; 95% CI, 2.1-6.1), dysuria, frequency, or both (LR range, 2.2-2.8), and new-onset urinary incontinence (LR, 4.6; 95% CI, 2.8-7.6) increased the likelihood of a UTI. Conclusions: Although individual signs and symptoms were helpful in the diagnosis of a UTI, they were not sufficiently accurate to definitively diagnose UTIs. Combination of findings can identify infants with a low likelihood of a UTI. ©2007 American Medical Association. All rights reserved.
Share
Citation/Export: |
|
Social Networking: |
|
Details
Item Type: |
Article
|
Status: |
Published |
Creators/Authors: |
Creators | Email | Pitt Username | ORCID  |
---|
Shaikh, N | nas67@pitt.edu | NAS67 | | Morone, NE | | | | Lopez, J | | | | Chianese, J | | | | Sangvai, S | | | | D'Amico, F | | | | Hoberman, A | | | | Wald, ER | | | |
|
Date: |
26 December 2007 |
Date Type: |
Publication |
Journal or Publication Title: |
JAMA - Journal of the American Medical Association |
Volume: |
298 |
Number: |
24 |
Page Range: |
2895 - 2904 |
DOI or Unique Handle: |
10.1001/jama.298.24.2895 |
Schools and Programs: |
School of Medicine > Pediatrics |
Refereed: |
Yes |
ISSN: |
0098-7484 |
MeSH Headings: |
Adolescent; Algorithms; Child; Child, Preschool; Diagnosis, Differential; Female; Fever; Humans; Infant; Male; Urinalysis; Urinary Tract Infections--diagnosis; Urinary Tract Infections--epidemiology |
PubMed ID: |
18159059 |
Date Deposited: |
13 Sep 2012 20:04 |
Last Modified: |
04 Feb 2019 15:58 |
URI: |
http://d-scholarship.pitt.edu/id/eprint/14078 |
Metrics
Monthly Views for the past 3 years
Plum Analytics
Altmetric.com
Actions (login required)
 |
View Item |