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Rule Out UTI. Shaikh N et al. Prevalence of urinary tract infections in childhood. A meta- analysis. Ped Infect Dis J 2008.

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Presentation on theme: "Rule Out UTI. Shaikh N et al. Prevalence of urinary tract infections in childhood. A meta- analysis. Ped Infect Dis J 2008."— Presentation transcript:

1 Rule Out UTI

2 Shaikh N et al. Prevalence of urinary tract infections in childhood. A meta- analysis. Ped Infect Dis J 2008

3 Prevalence of Disease - Girls 3 – 6 mos: 5% or 1/20 6 – 12 mos: 8% or 1/12 12 – 24 mos: 2% or 1/50

4 Prevalence - Males Uncirc: 3 – 12 mos: 5-7% or 1/16- 1/20 Circ: 3 – 12 mos: 2% or 1/50

5 Reducing the number of tests by risk stratification

6 Marc Gorelick, Kathy Shaw, A. Hoberman Clinical decision rule to identify febrile young girls at risk for urinary tract infection. Arch Pediatr Adolesc Med 2000. Validation of a decision rule identifying febrile young girls at high risk for urinary tract infection. Ped Emerg Care 2003.

7 Decision Rule? – No Decision Guideline? - Yes

8 Decision Guideline Excludes: Kids with obvious bacterial cause of fever – meningitis, pneumonia, strep pharyngitis Kids with definitive viral dx – Varicella, Coxsackie, Herpetic stomatitis Kids with HSP, Kawasaki’s

9 Girls < 2 years 2 or more of: »T > 39 o C »white »age < 12 months »no other source of fever »fever > 2 days past history of UTI symptoms specific to UTI

10 13 m Hisp female with 103 fever Fever for one day URI on exam No hx of UTI or UTI sx = No need to do U/A

11 9 m Cauc female with 101.5 Fever for 3 days No URI or AGE No hx of UTI or UTI sx = Get a urine

12 Boys < 1 year uncircumcised, or age < 6 months and no other source of fever past history of UTI symptoms specific to UTI

13 Diagnostic Testing Urine dipstick for LE, Nitrite

14 What is a positive? 1+ LE or greater + Nitrite whether or not LE is positive

15 Dip - Diagnostic Accuracy: Sensitivity ~ 85% Specificity ~ 90%

16 After dip, what is chance of disease? Dip negative – if chance of UTI was ~ 1/20, now ~ 1/120 Dip positive – if chance of UTI was ~ 1/20, now between 1/2 to 1/3 chance

17 Eliminate the Gram Stain in Kids Over 3 months

18 Cystitis and Urine Culturing Cystitis must be clearly defined

19 Considering Eliminating Culture Dysuria, frequency. Age > 3 years No evidence of upper tract disease – fever, back pain, vomiting, abd pain. No UTI in the last year LE and Nitrite Positive No chance of Herpes Labialis or STD


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