Urinalysis is not reliable to detect a urinary tract infection in febrile infants presenting to the ED.
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 degrees C or if they were between 3 and 24 months of age and had a temperature of at least 39 degrees 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%).


CONCLUSIONS
Urinalysis is not reliable for the detection of urinary tract infections in febrile infants when compared with urine cultures.
Department of Emergency Medicine, Naval Medical Center San Diego, CA 92134, USA.
Jacqueline M
JM
Reardon
Keri L
KL
Carstairs
Sherri L
SL
Rudinsky
Leslie V
LV
Simon
Robert H
RH
Riffenburgh
David A
DA
Tanen
D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D005260:Female; D005334:Fever; D006801:Humans; D007223:Infant; D008297:Male; D011237:Predictive Value of Tests; D012042:Registries; D016482:Urinalysis; D014552:Urinary Tract Infections / Q000175:diagnosis*; D014556:Urine / Q000382:microbiology*