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 degrees 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 degrees 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 degrees 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.
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 degrees 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 degrees 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 degrees 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.
Authors: Bas S H J Zegers; Pauline L H Winkler-Seinstra; Cuno S P M Uiterwaal; Tom V P M de Jong; Jan L L Kimpen; Catharine C E de Jong-de Vos van Steenwijk Journal: Pediatr Nephrol Date: 2008-12-09 Impact factor: 3.714
Authors: Alastair D Hay; Jonathan A C Sterne; Kerenza Hood; Paul Little; Brendan Delaney; William Hollingworth; Mandy Wootton; Robin Howe; Alasdair MacGowan; Michael Lawton; John Busby; Timothy Pickles; Kate Birnie; Kathryn O'Brien; Cherry-Ann Waldron; Jan Dudley; Judith Van Der Voort; Harriet Downing; Emma Thomas-Jones; Kim Harman; Catherine Lisles; Kate Rumsby; Stevo Durbaba; Penny Whiting; Christopher C Butler Journal: Ann Fam Med Date: 2016-07 Impact factor: 5.166
Authors: Christopher C Butler; Jonathan Ac Sterne; Michael Lawton; Kathryn O'Brien; Mandy Wootton; Kerenza Hood; William Hollingworth; Paul Little; Brendan C Delaney; Judith van der Voort; Jan Dudley; Kate Birnie; Timothy Pickles; Cherry-Ann Waldron; Harriet Downing; Emma Thomas-Jones; Catherine Lisles; Kate Rumsby; Stevo Durbaba; Penny Whiting; Kim Harman; Robin Howe; Alasdair MacGowan; Margaret Fletcher; Alastair D Hay Journal: Br J Gen Pract Date: 2016-07 Impact factor: 5.386