Does this child has UTI?

Pretest possibility of UTI in kids <2 yo

  • Female ~7% in <1 yo, ~2% in >1 yo
  • Male ~6% if uncircumcised, ~1% if circumsized
  • However, should remember that this data is from foreign studies. Should adjust according to local settings.
    – General rule is female has higher risk than male.
    – Male has higher risk if uncircumcised or <6 months.

The best symptoms for UTI in kids <2 yo are

  • Fever > 1 day  (LR 3.2-3.3)
  • Suprapubic tenderness (LR 4.4)
  • History of previous UTI (LR 2.3-2.9)
  • Using a combination of findings is better than using isolated findings.

Risk of UTI in kids >2 yo (i.e verbal)

  • Female~7-8%, male <1%

The best symptoms for these kids are

  • Abdominal pain (LR 6.3)
  • Back pain (LR 3.6)
  • New onset urinary incontinence (LR 5)
  • Typical symptoms like dysuria and frequency have LR ❤

Conclusion

  1. <2 yo: watch out for febrile suprapubic tenderness + history of previous UTI should also make you consider the presence of UTI. Not circumcised puts the child at higher risk.
  2. >2 yo: symptoms of typical UTI are not that reliable. If they are absent, watch out for abdominal pain/back pain + new onset of urinary incontinence.

Reference:

Nader Shaikh; Natalia E. Morone; John Lopez; et al. Does This Child Have a Urinary Tract Infection? JAMA. 2007;298(24):2895-2904

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