Abstract:
STUDY OBJECTIVE:The presence of leukocyte esterase by urine dipstick and microscopic pyuria are both indicators of possible urinary tract infection. The effect of urine concentration on the diagnostic performance of the urinalysis for pediatric urinary tract infection has not been studied. Our objective is to determine whether the urinalysis performance for detecting urinary tract infection varies by urine concentration as measured by specific gravity. METHODS:This was a retrospective cross-sectional study of the urine laboratory results of children younger than 13 years who presented to the emergency department during 68 months and had a paired urinalysis and urine culture obtained. Urinary tract infection was defined as pure growth of a uropathogen at standard culture thresholds. Test characteristics were calculated across 4 specific gravity groups (1.000 to 1.010, 1.011 to 1.020, 1.021 to 1.030, and >1.030). RESULTS:In total, 14,971 cases were studied. Median age was 1.5 years (interquartile range 0.4 to 5.5 years) and 60% were female patients. Prevalence of urinary tract infection was 7.7%. For the presence of leukocyte esterase and a range of pyuria cut points, the positive likelihood ratios decreased with increasing specific gravity. From most dilute to most concentrated urine, the positive likelihood ratio decreased from 12.1 (95% confidence interval [CI] 10.7 to 13.7) to 4.2 (95% CI 3.0 to 5.8) and 9.5 (95% CI 8.6 to 10.6) to 5.5 (95% CI 3.3 to 9.1) at a threshold of greater than or equal to 5 WBCs per high-power field and presence of leukocyte esterase, respectively. The negative likelihood ratios increased with increasing specific gravity for leukocyte esterase and microscopic pyuria. CONCLUSION:For the detection of pediatric urinary tract infection, the diagnostic performance of both dipstick leukocyte esterase and microscopic pyuria varies by urine concentration, and therefore the specific gravity should be considered when the urinalysis is interpreted.
journal_name
Ann Emerg Medjournal_title
Annals of emergency medicineauthors
Chaudhari PP,Monuteaux MC,Shah P,Bachur RGdoi
10.1016/j.annemergmed.2016.11.042subject
Has Abstractpub_date
2017-07-01 00:00:00pages
63-71.e8issue
1eissn
0196-0644issn
1097-6760pii
S0196-0644(16)31512-8journal_volume
70pub_type
杂志文章abstract::Situated in the heart of Europe, Switzerland's 7 million inhabitants, including 1 million foreigners, live in an area of 41,000 km2. German, French, Italian, and Rhaeto-Romanic are the official languages. The Swiss health service stands out because of the high quality and efficiency of its ambulatory and hospitalized ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(98)70144-1
更新日期:1998-08-01 00:00:00
abstract:STUDY OBJECTIVE:We examine the central venous catheter placement rate during the implementation of an ultrasound-guided peripheral intravenous access program. METHODS:We conducted a time-series analysis of the monthly central venous catheter rate among adult emergency department (ED) patients in an academic urban ED b...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2012.09.016
更新日期:2013-02-01 00:00:00
abstract::We report the cases of two children with acute plastic fractures of the long bones following trauma. Bowing deformity was evident clinically and radiographically in both cases. The unique radiologic features consisted of absence of fracture lines and of periosteal new bone formation during the healing phase. The mecha...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(86)80997-0
更新日期:1986-05-01 00:00:00
abstract:STUDY OBJECTIVE:We assess the effectiveness of patient-controlled analgesia in the emergency department (ED). We hypothesized that decline in pain intensity from 30 to 120 minutes after initial intravenous opioid administration is greater in patients receiving morphine by patient-controlled analgesia compared with usua...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.annemergmed.2017.03.064
更新日期:2017-12-01 00:00:00
abstract::An important aspect in the effective management of an emergency medical services system is the ability to monitor system performance. To provide this information on a timely basis, a comprehensive data collection system is required. We describe the design, implementation, use, and effect of a comprehensive, computeriz...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(89)80847-9
更新日期:1989-05-01 00:00:00
abstract::A 39-year-old woman presented to the emergency department with symptoms of acute knifelike chest pain and was discharged with a diagnosis of musculoskeletal pain syndrome. One day later, she returned with a complaint of persistent chest pain. Physical examination disclosed meningismus, this led to a lumbar puncture an...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(88)80682-6
更新日期:1988-09-01 00:00:00
abstract:STUDY OBJECTIVE:To evaluate the potential for cardiovascular toxicity from severe oral phenytoin overdose. STUDY POPULATION:Fifty-seven patients admitted during a two-year period to an inner-city hospital for severe oral phenytoin overdose, which is defined as a peak level of 40 micrograms/mL or more. METHODS:Case re...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)81604-x
更新日期:1991-05-01 00:00:00
abstract:STUDY OBJECTIVES:To determine the sensitivity, specificity, and predictive values of a new rapid creatine kinase-MB (R-CK-MB) assay compared with a standard CK-MB (S-CK-MB) assay and to determine its potential use in the evaluation of emergency department patients with possible myocardial infarction. DESIGN:Retrospect...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)82971-3
更新日期:1991-09-01 00:00:00
abstract::We present the cases of three patients with skin blisters following carbon monoxide (CO) poisoning. Their blisters appeared to be related to the severity of the poisoning (HbCO levels of more than 40%). Two of the three patients died despite aggressive initial 100% surface oxygen followed by hyperbaric oxygen therapy....
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(85)80792-7
更新日期:1985-06-01 00:00:00
abstract:STUDY OBJECTIVE:We sought to examine the outcome of a subgroup of patients with extreme carbon monoxide (CO) poisoning, specifically those discovered in cardiac arrest, resuscitated, and subsequently treated with hyperbaric oxygen (HBO(2)). Opinions of hyperbaric medicine physicians regarding the treatment of such pati...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1067/mem.2001.115532
更新日期:2001-07-01 00:00:00
abstract:STUDY OBJECTIVE:To determine the accuracy of four methods of endotracheal tube size selection in the pediatric population. STUDY DESIGN:Prospective, blinded comparison. SETTING:The Children's Hospital of Philadelphia. PARTICIPANTS:Two hundred thirty-seven children aged 1 month to 9 years old undergoing elective surg...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)81937-7
更新日期:1993-03-01 00:00:00
abstract:STUDY OBJECTIVE:The European Cooperative Acute Stroke Study III (ECASS III) showed that recombinant tissue plasminogen activator (rtPA) administered 3 to 4.5 hours after acute ischemic stroke led to improvement in patient disability versus placebo. We evaluate the long-term incremental cost-effectiveness of rtPA admini...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2012.04.020
更新日期:2013-01-01 00:00:00
abstract:STUDY OBJECTIVES:By evaluating the efficacy of metoclopramide alone and in combination with ibuprofen versus placebos, this study was designed to both evaluate the efficacy of metoclopramide and elucidate its mechanism of action in the treatment of migraine headache. DESIGN:The study was conducted over a two-year peri...
journal_title:Annals of emergency medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0196-0644(05)80201-x
更新日期:1993-02-01 00:00:00
abstract:STUDY OBJECTIVE:The primary objective is to compare total sedation time when ketamine/propofol is used compared with ketamine alone for pediatric procedural sedation and analgesia. Secondary objectives include time to recovery, adverse events, efficacy, and satisfaction scores. METHODS:Children (aged 2 to 17 years) re...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.annemergmed.2010.08.032
更新日期:2011-05-01 00:00:00
abstract:STUDY OBJECTIVE:We develop a comprehensive view of aspects of care associated with parental satisfaction with pediatric emergency department (ED) visits, using both quantitative and qualitative data. METHODS:This was a retrospective observational study using data from an institution-wide system to measure patient sati...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2013.04.025
更新日期:2013-10-01 00:00:00
abstract::Post-dural-puncture headache is a common complication after both diagnostic and therapeutic procedures. Prompt recognition of the clinical syndrome, followed by supportive and corrective actions, can decrease the morbidity in those afflicted. The most useful preventive measure during dural puncture in adult patients i...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,评审
doi:10.1016/s0196-0644(05)80416-0
更新日期:1993-12-01 00:00:00
abstract::Gifts to physicians by the pharmaceutical industry pose numerous ethical questions. Although individual patients and physicians may benefit financially and educationally from certain gifts, the risk of bias resulting from such gifts makes them ethically challenging. After a brief description of the nature and scope of...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2005.12.013
更新日期:2006-11-01 00:00:00
abstract::As the only medical specialists who routinely provide continuous 24-hour daily coverage, emergency physicians are all too familiar with the demands of shift work. Although shift work has a pervasive effect on the practice of emergency medicine and is regarded as a major stressor, it has received little attention per s...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,评审
doi:10.1016/s0196-0644(05)81758-5
更新日期:1992-10-01 00:00:00
abstract:STUDY OBJECTIVE:Recent studies have demonstrated that a single episode of acute kidney injury from a number of causes can increase the risk of severe long-term outcomes, including major cardiovascular events and death. We tested the hypothesis that patients who develop acute kidney injury consistent with contrast-induc...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2015.04.028
更新日期:2015-09-01 00:00:00
abstract::While remaining prominent in paramedic care and beneficial to some patients, out-of-hospital endotracheal intubation has not clearly improved survival or reduced morbidity from critical illness or injury when studied more broadly. Recent studies identify equivocal or unfavorable clinical effects, adverse events and er...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2006.01.016
更新日期:2006-06-01 00:00:00
abstract::Clinical studies on the use of magnesium in acute myocardial infarction have yielded contradictory results. While the exact reasons for these discrepancies are unclear, it appears that the timing of magnesium administration is crucial to the success or failure of therapy. Although some studies have shown a significant...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,评审
doi:10.1016/s0196-0644(94)70248-9
更新日期:1994-12-01 00:00:00
abstract::Several clinical studies have yielded conflicting results in examining the effectiveness of bystander CPR (BCPR). The purpose of this pilot study was to determine the effectiveness of BCPR in an animal model of cardiac arrest and resuscitation. Ten swine were instrumented for hemodynamic and regional blood flow measur...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)81561-6
更新日期:1990-08-01 00:00:00
abstract::Colloid cyst of the third ventricle, although a benign lesion, carries with it high mortality and morbidity if not diagnosed in time. The most common presenting symptom is headache. A 31-year-old man with a history of intermittent, throbbing, unilateral headache and nausea was admitted because of exacerbation of his h...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(83)80260-1
更新日期:1983-12-01 00:00:00
abstract:STUDY OBJECTIVES:To develop a practical procedure for producing a nomogram describing the relationship between the osmolality gap and serum ethanol concentrations that is appropriate for the formulas and analytical methodologies in use at any laboratory. DESIGN:Retrospective review of serum sodium, glucose, urea nitro...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)81899-2
更新日期:1992-11-01 00:00:00
abstract:STUDY OBJECTIVE:The benefit of epinephrine in cardiac arrest is controversial and has not been conclusively shown in any human clinical study. We seek to assess the effect of introducing intravenous epinephrine on the survival outcomes of out-of-hospital cardiac arrest patients in an emergency medical services (EMS) sy...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2007.03.028
更新日期:2007-12-01 00:00:00
abstract:STUDY OBJECTIVES:To assess the timing of key decisions and clinical events in the treatment of acute myocardial infarction with thrombolytic therapy. DESIGN:Prospective study of emergency department patients. SETTING:EDs in 11 urban and two rural hospitals. TYPES OF PARTICIPANTS:Patients with presumed acute myocardi...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,多中心研究
doi:10.1016/s0196-0644(05)81749-4
更新日期:1992-10-01 00:00:00
abstract::This review synthesizes the existing literature to provide evidence-based predictions for the future of emergency care in the United States as a result of the Patient Protection and Affordable Care Act, with a focus on emergency department (ED) visit volume, acuity, and reimbursement. Patient behavior will likely be q...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,评审
doi:10.1016/j.annemergmed.2015.04.007
更新日期:2015-11-01 00:00:00
abstract:STUDY PURPOSE:To determine the ability of clinicians to predict the results of emergency head computed tomography (CT) scans. METHODS:Clinicians requesting cranial CT scans from the emergency department prospectively filled out a form detailing their patients' complaints, possible diagnoses, and the likelihood of find...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(94)70351-5
更新日期:1994-06-01 00:00:00
abstract:STUDY OBJECTIVE:The potential of infectious disease spread in diseases such as tuberculosis, infectious disease epidemic such as avian flu and the threat of terrorism with agents capable of airborne transmission have focused attention on the need for increased surge capacity for patient isolation. Total negative pressu...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2007.04.017
更新日期:2008-04-01 00:00:00
abstract::Right ventricular infarction due to ischemic heart disease can be diagnosed by a right precordial electrogram or by first-pass radionuclide angiography (FPRNA). Prior FPRNA studies have shown that cardiac dysfunction after blunt chest trauma (myocardial contusion) is most often due to right ventricular dysfunction. We...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(88)80665-6
更新日期:1988-09-01 00:00:00