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Does this child have a urinary tract infection?

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

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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.


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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Shaikh, Nnas67@pitt.eduNAS67
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


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