Clinical decision rule to identify febrile young girls at risk for urinary tract infection

Arch Pediatr Adolesc Med. 2000 Apr;154(4):386-90. doi: 10.1001/archpedi.154.4.386.


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 > or =38.3 degrees 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 10(4) 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 degrees 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.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Decision Making*
  • Fever / etiology
  • Humans
  • Infant
  • Predictive Value of Tests
  • Prospective Studies
  • Urinary Tract Infections / diagnosis*
  • Urinary Tract Infections / urine