Abstract:
PURPOSE:Up to 50% of urinary tract infections (UTIs) in young children are missed in primary care. Urine culture is essential for diagnosis, but urine collection is often difficult. Our aim was to derive and internally validate a 2-step clinical rule using (1) symptoms and signs to select children for urine collection; and (2) symptoms, signs, and dipstick testing to guide antibiotic treatment. METHODS:We recruited acutely unwell children aged under 5 years from 233 primary care sites across England and Wales. Index tests were parent-reported symptoms, clinician-reported signs, urine dipstick results, and clinician opinion of UTI likelihood (clinical diagnosis before dipstick and culture). The reference standard was microbiologically confirmed UTI cultured from a clean-catch urine sample. We calculated sensitivity, specificity, and area under the receiver operator characteristic (AUROC) curve of coefficient-based (graded severity) and points-based (dichotomized) symptom/sign logistic regression models, and we then internally validated the AUROC using bootstrapping. RESULTS:Three thousand thirty-six children provided urine samples, and culture results were available for 2,740 (90%). Of these results, 60 (2.2%) were positive: the clinical diagnosis was 46.6% sensitive, with an AUROC of 0.77. Previous UTI, increasing pain/crying on passing urine, increasingly smelly urine, absence of severe cough, increasing clinician impression of severe illness, abdominal tenderness on examination, and normal findings on ear examination were associated with UTI. The validated coefficient- and points-based model AUROCs were 0.87 and 0.86, respectively, increasing to 0.90 and 0.90, respectively, by adding dipstick nitrites, leukocytes, and blood. CONCLUSIONS:A clinical rule based on symptoms and signs is superior to clinician diagnosis and performs well for identifying young children for noninvasive urine sampling. Dipstick results add further diagnostic value for empiric antibiotic treatment.
journal_name
Ann Fam Medjournal_title
Annals of family medicineauthors
Hay AD,Sterne JA,Hood K,Little P,Delaney B,Hollingworth W,Wootton M,Howe R,MacGowan A,Lawton M,Busby J,Pickles T,Birnie K,O'Brien K,Waldron CA,Dudley J,Van Der Voort J,Downing H,Thomas-Jones E,Harman K,Lisles C,doi
10.1370/afm.1954subject
Has Abstractpub_date
2016-07-01 00:00:00pages
325-36issue
4eissn
1544-1709issn
1544-1717pii
14/4/325journal_volume
14pub_type
杂志文章,多中心研究abstract:PURPOSE:Persons with multiple chronic diseases must integrate self-management tasks for potentially interacting conditions to attain desired clinical outcomes. Our goal was to identify barriers to self-management that were associated with lower perceived health status and, secondarily, with lower reported physical func...
journal_title:Annals of family medicine
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journal_title:Annals of family medicine
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journal_title:Annals of family medicine
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pub_type: 杂志文章,多中心研究,随机对照试验
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