title: Predicting anatomical urological abnormalities in children who present with their first urinary tract infection.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Urology, Children's Hospital, Boston, Boston, MA 02115, USA.
authors.forename: Vitor C
authors.initials: VC
authors.lastname: Zanetta
authors.forename: Brian M
authors.initials: BM
authors.lastname: Rosman
authors.forename: Courtney K
authors.initials: CK
authors.lastname: Rowe
authors.forename: Helena B
authors.initials: HB
authors.lastname: Buonfiglio
authors.forename: Carlo C
authors.initials: CC
authors.lastname: Passerotti
authors.forename: Richard N
authors.initials: RN
authors.lastname: Yu
authors.forename: Hiep T
authors.initials: HT
authors.lastname: Nguyen
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D014551:Urinary Tract / Q000002:abnormalities*; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000453:epidemiology; D014564:Urogenital Abnormalities / Q000175:diagnosis* / Q000453:epidemiology; D014718:Vesico-Ureteral Reflux / Q000175:diagnosis* / Q000453:epidemiology
keywords: children; fever; urinary tract infection; vesicoureteral reflux