Predicting anatomical urological abnormalities in children who present with their first urinary tract infection

• Published in: Clinical pediatrics Vol. 52; no. 8; p. 739
• Main Authors: Zanetta, Vitor C, Rosman, Brian M, Rowe, Courtney K, Buonfiglio, Helena B, Passerotti, Carlo C, Yu, Richard N, Nguyen, Hiep T
• Format: Journal Article
• Language: English
• Published: United States 01.08.2013
• Subjects: Adolescent; Age Distribution; Analysis of Variance; Child; Child, Preschool; Cohort Studies; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Incidence; Logistic Models; Male; Multivariate Analysis; Predictive Value of Tests; Retrospective Studies; Risk Assessment; ROC Curve; Severity of Illness Index; Sex Distribution; Urinary Tract - abnormalities; Urinary Tract Infections - diagnosis; Urinary Tract Infections - epidemiology; Urogenital Abnormalities - diagnosis; Urogenital Abnormalities - epidemiology; Vesico-Ureteral Reflux - diagnosis; Vesico-Ureteral Reflux - epidemiology; fever; children; vesicoureteral reflux; urinary tract infection
• ISSN: 1938-2707
• DOI: 10.1177/0009922813485284

Classically, presence of fever≥38.0°C is used to distinguish pyelonephritis from cystitis. We analyzed whether this is an appropriate marker to initiate further workup and whether temperature is correlated with urological abnormalities and further surgical or pharmacological intervention. Children who presented for their first workup of urinary tract infection between October 1, 2008, and September 30, 2009 were retrospectively selected from our institution. Demographics and clinical details were correlated with the diagnosis of urological abnormalities and requirement for intervention. Age was the most important variable to predict urological abnormalities. The temperature value of 38.3°C maximized the balance between sensitivity (90%) and specificity (46%) for predicting the need to intervene and the presence of anatomical urological abnormalities. Young age (≤2 years) and temperature are the best factors to predict further intervention and urological abnormalities, with a temperature value of 38.3°C being a better predictive value than the currently used 38.0°C.