Does this child have a urinary tract infection?
Does this child have a urinary tract infection?
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DOI：
10.1001/jama.298.24.2895
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发表时间：
2007-12-26
影响因子：
120.7
通讯作者：
Wald, Ellen R.
中科院分区：
文献类型：
--
作者：
Shaikh, Nader;Morone, Natalia E.;Wald, Ellen R.
尿路感染 (UTI) 是一种常见的儿科疾病，如果不及时治疗，可能会导致永久性肾损伤。因此，尿路感染的准确诊断非常重要。 目的 评价症状和体征诊断婴儿和儿童尿路感染的准确性。 数据来源 对 1966 年至 2007 年 10 月期间发表的文章进行 MEDLINE 和 EMBASE 数据库检索，并对所有符合纳入标准的文章的参考书目进行人工审查、之前发表的 1 篇系统综述、3 本临床技能教科书和 2 名该领域的专家，共获得 6988 篇潜在相关文章如果研究包含 18 岁以下儿童 UTI 体征或症状的数据，则纳入研究选择研究。在检查的 337 篇文章中，有 12 篇符合所有纳入标准。 数据提取 两名评估员独立审查、评分并从每篇文章中提取数据。 数据合成 在发烧婴儿中，既往有 UTI 病史（似然比 [LR] 范围，2.3-2.9）、体温高于 40°C（LR 范围，3.2-3.3）和耻骨上压痛（LR，4.4；95% 置信区间 [ CI]，1.6-12.4）是对于识别患有尿路感染的人最有用的发现。在男婴中，缺乏包皮环切会增加尿路感染的可能性（总结 LR，2.8；95% CI，1.9-4.3）；包皮环切术的存在是 LR 小于 0.5 的唯一发现（总结 LR，0.33；95% CI，0.18-0.63）。在识别患有 UTI 的婴儿时，综合结果比单独的结果更有用（对于体温 > 39 摄氏度，持续 > 48 小时且检查时没有其他潜在发热源的情况，所有结果的 LR 为 4.0；95% CI，1.2-13.0；对于体温
Context Urinary tract infection ( UTI) is a frequently occurring pediatric illness that, if left untreated, can lead to permanent renal injury. Accordingly, accurate diagnosis of UTI is important.Objective To review the diagnostic accuracy of symptoms and signs for the diagnosis of UTI in infants and children.Data Sources A search of MEDLINE and EMBASE databases was conducted for articles published between 1966 and October 2007, as well as a manual review of bibliographies of all articles meeting inclusion criteria, 1 previously published systematic review, 3 clinical skills textbooks, and 2 experts in the field, yielding 6988 potentially relevant articles.Study Selection Studies were included if they contained data on signs or symptoms of UTI in children through age 18 years. Of 337 articles examined, 12 met all inclusion criteria.Data Extraction Two evaluators independently reviewed, rated, and abstracted data from each article.Data Synthesis In infants with fever, history of a previous UTI ( likelihood ratio [ LR] range, 2.3- 2.9), temperature higher than 40 C ( LR range, 3.2- 3.3), and suprapubic tenderness ( LR, 4.4; 95% confidence interval [ CI], 1.6- 12.4) were the findings most useful for identifying those with a UTI. Among male infants, lack of circumcision increased the likelihood of a UTI ( summary LR, 2.8; 95% CI, 1.9- 4.3); and the presence of circumcision was the only finding with an LR of less than 0.5 ( summary LR, 0.33; 95% CI, 0.18- 0.63). Combinations of findings were more useful than individual findings in identifying infants with a UTI ( for temperature > 39 degrees C for >48 hours without another potential source for fever on examination, the LR for all findings present was 4.0; 95% CI, 1.2- 13.0; and for temperature