title: Emergency Hospital Admissions for Initial Febrile Urinary Tract Infection: Do Patient Demographics Matter?
abstract: BACKGROUND
  In 2011, the American Academy of Pediatrics revised practice parameters regarding febrile urinary tract infection (fUTI) in children aged 2-24 months. The Section on Urology opposed the omission of voiding cystourethrogram (VCUG), and expressed concern that potential untoward consequences of deferring VCUG may be most felt by children on Medicaid.
  
  
  OBJECTIVE
  We ascertained imaging and characteristics of children presenting to the Emergency Department (ED) with initial fUTI to determine the impact of patient demographics on admissions for pyelonephritis.
  
  
  METHODS
  Children aged 2-24 months presenting to the ED with initial fUTI were identified. Demographics, insurance status, laboratory studies, renal-bladder ultrasound (RBUS), VCUG, and hospital admission status were evaluated.
  
  
  RESULTS
  Three-hundred fifty patients met inclusion criteria; 88 (25.1%) were admitted. Admitted patients were significantly (p < 0.001) younger (mean 0.31 ± 0.33 years) than those managed as outpatients (mean 0.91 ± 0.7 years). On univariate analysis, male gender (p < 0.001), Medicaid insurance (p < 0.05), and non-Hispanic race (p < 0.05) were associated with admission. Race retained significance on multivariate analysis; Caucasian children were 2.35 times (95% confidence interval [CI] 0.79-7.23) and African-American children 3.8 times more likely to be admitted than Hispanic patients (95% CI 1.88-7.63). Children with abnormal RBUS were 12.8 times more likely to require admission (95% CI 4.44-37.0). Medicaid was also independently predictive of admission; such patients were 2.6 times more likely to be admitted than those with private insurance (95% CI 1.15-5.88).
  
  
  CONCLUSIONS
  Abnormal ultrasound, non-Hispanic race, and public insurance were strongly associated with hospital admission in children presenting to the ED with initial febrile urinary tract infection.
authors: Children's Healthcare of Atlanta, Atlanta, Georgia.
authors: Angela M
authors: AM
authors: Arlen
authors: Children's Healthcare of Atlanta, Atlanta, Georgia.
authors: Laura S
authors: LS
authors: Merriman
authors: Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University School of Medicine, Atlanta, Georgia.
authors: Traci
authors: T
authors: Leong
authors: Children's Healthcare of Atlanta, Atlanta, Georgia.
authors: Jared M
authors: JM
authors: Kirsch
authors: Children's Healthcare of Atlanta, Atlanta, Georgia.
authors: Edwin A
authors: EA
authors: Smith
authors: Children's Healthcare of Atlanta, Atlanta, Georgia.
authors: Bruce H
authors: BH
authors: Broecker
authors: Children's Healthcare of Atlanta, Atlanta, Georgia.
authors: Andrew J
authors: AJ
authors: Kirsch
mesh_terms: D003710:Demography; D004636:Emergency Service, Hospital; D005260:Female; D005334:Fever / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008297:Male; D008484:Medicaid; D010343:Patient Admission / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000453:epidemiology*
keywords: Medicaid; demographics; guidelines; hospital admission; pyelonephritis