Clinical Features for the Diagnosis of Pediatric Urinary Tract Infections: Systematic Review and Meta-Analysis

Abstract

PURPOSE Accurate diagnosis of urinary tract infection in children is essential because children left untreated can experience permanent renal injury. We aimed to assess the diagnostic value of clinical features of pediatric urinary tract infection. METHODSWe performed a systematic review and meta-analysis of diagnostic test accuracy studies in ambulatory care. We searched the PubMed, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Health Technology Assessment, and Database of Abstracts of Reviews of Effects databases from inception to January 27, 2020 for studies reporting 2 × 2 diagnostic accuracy data for clinical features compared with urine culture in children aged <18 years. For each clinical feature, we calculated likelihood ratios and posttest probabilities of urinary tract infection. To estimate summary parameters, we conducted a bivariate random effects metaanalysis and hierarchical summary receiver operating characteristic analysis. RESULTSA total of 35 studies (N = 78,427 patients) of moderate to high quality were included, providing information on 58 clinical features and 6 prediction rules. Only circumcision (negative likelihood ratio [LR-] 0.24; 95% CI, 0.08-0.72; n = 8), stridor (LR-0.20; 95% CI, 0.05-0.81; n = 1), and diaper rash (LR-0.13; 95% CI, 0.02-0.92; n = 1) were useful for ruling out urinary tract infection. Body temperature or fever duration showed limited diagnostic value (area under the receiver operating characteristic curve 0.61; 95% CI, 0.47-0.73; n = 16). The Diagnosis of Urinary Tract Infection in Young Children score, Gorelick Scale score, and UTIcalc (https://uticalc.pitt.edu) might be useful to identify children eligible for urine sampling.CONCLUSIONS Few clinical signs and symptoms are useful for diagnosing or ruling out urinary tract infection in children. Clinical prediction rules might be more accurate; however, they should be validated externally. Physicians should not restrict urine sampling to children with unexplained fever or other features suggestive of urinary tract infection.

Design and Optimization of Urinary Real-Time Nursing Model Based on Medical Internet of Things

“…The medical IoTs support multiple access operations such as mobile terminal applications, which can realize urinary real-time nursing status monitoring and intelligent management. The urinary real-time nursing model uses cloud computing technology to build a centralized management model of medical nursing, which has great advantages compared with the traditional decentralized and independent model [ 17 ]. The establishment of patient nursing files on the basis of the medical IoTs is to record all the health information of each patient.…”

Outpatient urine collection methods for paediatric urinary tract infections: Systematic review of diagnostic accuracy studies

“…Diagnosis is challenging, as only a minority of children with UTI present with typical UTI symptoms. In a previous study, we found that changes in urine appearance, such as cloudy urine, malodorous urine and haematuria, are alarming signs for UTI, while only few features (e.g., circumcision, stridor) lower the probability of UTI considerably 5 …”

“…In a previous study, we found that changes in urine appearance, such as cloudy urine, malodorous urine and haematuria, are alarming signs for UTI, while only few features (e.g., circumcision, stridor) lower the probability of UTI considerably. 5 Because the clinical presentation is often unclear, primary care physicians need appropriate collection methods for urine testing…”

GPs’ perspectives on diagnosing childhood urinary tract infections: a qualitative study

“…Only a few features, such as circumcision in boys, nappy rash, or the presence of stridor decrease the probability of UTI. 6 The absence of signs and symptoms of UTI in children makes it difficult to rule out UTI at an early stage.…”