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Clinical Decision Rule to Identify Febrile Young Girls at Risk for Urinary Tract Infection
Marc H. Gorelick, MD, MSCE;
Kathy N. Shaw, MD, MSCE
Arch Pediatr Adolesc Med. 2000;154:386-390.
Objective To develop a clinical prediction rule to identify febrile young girls needing urine culture for evaluation of urinary tract infection (UTI).
Design Prospective cohort study.
Setting Urban children's hospital emergency department.
Patients All girls younger than 2 years (N=1469) presenting to the emergency department with fever (temperature  38.3°C) and without an unequivocal source of fever during a 12-month period.
Main Outcome Measures The outcome of interest was UTI, defined as a catheterized urine culture with pure growth of 104 colonies/mL or greater. Candidate predictors included demographic, historical, and physical examination variables. Clinical prediction rules were developed using multiple logistic regression after screening variables for univariate association and reliability.
Results The presence of 2 or more of the following 5 variables—less than 12 months old, white race, temperature of 39.0°C or higher, fever for 2 days or more, and absence of another source of fever on examination—predicted UTI with a sensitivity of 0.95 (95% confidence interval, 0.85-0.99) and a specificity of 0.31 (95% confidence interval, 0.28-0.34). In the study population, with an overall prevalence of UTI of 4.3%, the positive predictive value of a score of 2 or more was 6.4% and the negative predictive value of a score of less than 2 was 0.8%.
Conclusion Using this clinical decision rule, a strategy of obtaining urine cultures from girls younger than 2 years with a score of 2 or more would lead to identification of 95% of children with UTI and elimination of 30% of unnecessary urine cultures.
From the Division of Emergency Medicine, A. I. duPont Hospital for Children, Wilmington, Del (Dr Gorelick); the Department of Pediatrics, Jefferson Medical College, Philadelphia, Pa (Dr Gorelick); the Division of Emergency Medicine, Children's Hospital of Philadelphia (Dr Shaw); and the Department of Pediatrics (Dr Shaw) and the Center for Clinical Epidemiology and Biostatistics (Drs Gorelick and Shaw), University of Pennsylvania School of Medicine, Philadelphia.
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