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Published byIsaac Boone Modified over 9 years ago
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Rule Out UTI
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Shaikh N et al. Prevalence of urinary tract infections in childhood. A meta- analysis. Ped Infect Dis J 2008
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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
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Prevalence - Males Uncirc: 3 – 12 mos: 5-7% or 1/16- 1/20 Circ: 3 – 12 mos: 2% or 1/50
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Reducing the number of tests by risk stratification
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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.
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Decision Rule? – No Decision Guideline? - Yes
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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
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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
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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
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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
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Boys < 1 year uncircumcised, or age < 6 months and no other source of fever past history of UTI symptoms specific to UTI
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Diagnostic Testing Urine dipstick for LE, Nitrite
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What is a positive? 1+ LE or greater + Nitrite whether or not LE is positive
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Dip - Diagnostic Accuracy: Sensitivity ~ 85% Specificity ~ 90%
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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
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Eliminate the Gram Stain in Kids Over 3 months
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Cystitis and Urine Culturing Cystitis must be clearly defined
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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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