Shaikh et al developed several algorithms for identifying young children with urinary tract infections (UTI). Male children from 3 to 24 months of age are at increased risk for a urinary tract infection. The authors are from the University of Pittsburgh, Ohio State University, Duquesne University and the University of Wisconsin.
Parameters:
(1) circumcision status
(2) number of risk factors for a urinary tract infection
(3) results of urinalysis (nitrite and leukocyte esterase on dipstick testing)
Risk factors for a UTI include:
(1) previous history of a urinary tract infection
(2) fever > 39°C
(3) fever without an apparent source
(4) child appears ill
(5) suprapubic tenderness
(6) fever lasting > 24 hours
(7) nonblack race
Circumcision Status
Number of Risk Factors
Urinalysis
Probability of UTI
no
0
NA
< 2%
no
>=1
neither positive
2 - 6%
no
>=1
one positive
40 - 66%
no
>=1
both positive
75 to 90%
yes
0 or 1
NA
< 2%
yes
>=2
neither positive
< 2%
yes
>=2
one positive
15 - 34%
yes
>=2
both positive
46 - 71%
where:
• As written any uncircumcised white or Hispanic male needs to have a urinalysis done.
A child with no risk factors should be re-evaluated at 24 hours to look for any evidence of a UTI (persistent fever might be enough to do additional testing).
A child who is at increased risk may need to be catheterized to obtain a valid specimen. A urine culture should be performed on the collected specimen so care should be taken in its collection.
To read more or access our algorithms and calculators, please log in or register.
