Urinalysis is not reliable to detect a urinary tract infection in febrile infants presenting to the ED☆
Received 23 June 2008; received in revised form 12 July 2008; accepted 13 July 2008.
Abstract
Objective
Urinary tract infections are a common source of serious bacterial infections in febrile infants younger than 2 years. Our objective was to compare urinalysis with urine culture in the emergency department evaluation of febrile infants.
Methods
A febrile infant registry was instituted at a tertiary care hospital treating an average of 55000 patients annually (27% children), from December 2002 to December 2003. Patients were eligible if they were younger than 3 months and had a temperature of at least 38°C or if they were between 3 and 24 months of age and had a temperature of at least 39°C. Data abstracted included age, sex, and temperature. Urinalysis (UA) and urine culture (UCx) results were obtained from electronic hospital archives.
Results
Nine hundred eighty-five patients were entered into the febrile infant registry. Male patients comprised 55%. The mean age of patients was 12.6 months; median was 12 months. Four hundred thirty-five (78% of eligible patients) had both a UA and UCx from the same specimen, and there were 45 (10.3%) positive UCx result. Females accounted for 33 (73%) of 45 positive results. The sensitivity of UA for predicting a positive UCx result was 64% (95% confidence interval [CI], 49%-78%), whereas the specificity was 91% (95% CI, 88%-94%). The positive predictive value was 46% (95% CI, 31%-53%), with a negative predictive value of 96% (95% CI, 93%-97%).
Conclusion
Urinalysis is not reliable for the detection of urinary tract infections in febrile infants when compared with urine cultures.
aDepartment of Emergency Medicine, Naval Medical Center San Diego, CA 92134, USA
bClinical Investigations Department, Naval Medical Center San Diego, CA 92134, USA
Corresponding author. Tel.: +1 619 532 8276.
☆ The Chief, Bureau of Medicine and Surgery, Navy Department, Washington, DC, Clinical Investigations Program, sponsored this report #S-05-075 as required by NSHBETHINST 6000.41B. The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States government.
Presented as a abstract at the American College of Emergency Physicians Scientific Assembly in New Orleans, La, in October of 2006.
ABSTRACT