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Robert H Pantell - One of the best experts on this subject based on the ideXlab platform.
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Choice of urine collection methods for the diagnosis of urinary tract infection in young, Febrile Infants
Archives of pediatrics & adolescent medicine, 2005Co-Authors: Alan R. Schroeder, Thomas B Newman, Stacia A Finch, Richard C Wasserman, Robert H PantellAbstract:Background The optimal method of urine collection in Febrile Infants is debatable; catheterization, considered more accurate, is technically difficult and invasive. Objectives To determine predictors of urethral catheterization in Febrile Infants and to compare bag and catheterized urine test performance characteristics. Design Prospective analysis of Infants enrolled in the Pediatric Research in Office Settings’ Febrile Infant Study. Setting A total of 219 practices from within the Pediatric Research in Office Settings’ network, including 44 states, the District of Columbia, and Puerto Rico. Patients A total of 3066 Infants aged 0 to 3 months with temperatures of 38°C or higher. Main Outcome Measures We calculated adjusted odds ratios for predictors of catheterization. Diagnostic test characteristics were compared between bag and catheterization. Urinary tract infection was defined as pure growth of 100 000 CFU/mL or more (bag) and 20 000 CFU/mL or more (catheterization). Results Seventy percent of urine samples were obtained by catheterization. Predictors of catheterization included female sex, practitioner older than 40 years, Medicaid, Hispanic ethnicity, nighttime evaluation, and severe dehydration. For leukocyte esterase levels, bag specimens demonstrated no difference in sensitivity but somewhat lower specificity (84% [bag] vs 94% [catheterization], P P = .01). Infection rates were similar in bag and catheterized specimens (8.5% vs 10.8%). Ambiguous cultures were more common in bag specimens (7.4% vs 2.7%, P Conclusions Most practitioners obtain urine from Febrile Infants via catheterization, but choice of method is not related to the risk of urinary tract infection. Although both urine cultures and urinalyses are more accurate in catheterized specimens, the magnitude of difference is small but should be factored into clinical decision making.
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urine testing and urinary tract infections in Febrile Infants seen in office settings the pediatric research in office settings Febrile Infant study
JAMA Pediatrics, 2002Co-Authors: Thomas B Newman, Jane Bernzweig, John I Takayama, Stacia A Finch, Richard C Wasserman, Robert H PantellAbstract:Objective To determine the predictors and results of urine testing of young Febrile Infants seen in office settings. Design Prospective cohort study. Setting Offices of 573 pediatric practitioners from 219 practices in the American Academy of Pediatrics Pediatric Research in Office Settings' research network. Subjects A total of 3066 Infants 3 months or younger with temperatures of 38°C or higher were evaluated and treated according to the judgment of their practitioners. Main Outcome Measures Urine testing results, early and late urinary tract infections (UTIs), and UTIs with bacteremia. Results Fifty-four percent of the Infants initially had urine tested, of whom 10% had a UTI. The height of the fever was associated with urine testing and a UTI among those tested (adjusted odds ratio per degree Celsius, 2.2 for both). Younger age, ill appearance, and lack of a fever source were associated with urine testing but not with a UTI, whereas lack of circumcision (adjusted odds ratio, 11.6), female sex (adjusted odds ratio, 5.4), and longer duration of fever (adjusted odds ratio, 1.8 for fever lasting ≥24 hours) were not associated with urine testing but were associated with a UTI. Bacteremia accompanied the UTI in 10% of the patients, including 17% of those younger than 1 month. Among 807 Infants not initially tested or treated with antibiotics, only 2 had a subsequent documented UTI; both did well. Conclusions Practitioners order urine tests selectively, focusing on younger and more ill-appearing Infants and on those without an apparent fever source. Such selective urine testing, with close follow-up, was associated with few late UTIs in this large study. Urine testing should focus particularly on uncircumcised boys, girls, the youngest and sickest Infants, and those with persistent fever.
Paul L. Mccarthy - One of the best experts on this subject based on the ideXlab platform.
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Observational Assessment in the Febrile Infant
Pediatrics, 2017Co-Authors: Paul L. MccarthyAbstract:* Abbreviations: SBI — : serious bacterial infection UCS — : unstructured clinical suspicion YOS — : Yale observation scale Febrile Infants 10; of the 23 Infants with meningitis assessed by UCS, only 11 had high scores. The YOS was developed to capture the instinctive clinical judgments that pediatricians make through observation to assess a child’s degree of illness.2 In analyzing 186 domains (eg, motor behavior) of observation data used to formulate these scales, ∼60% focused on the child’s response to stimuli.3 To accurately … Address correspondence to Paul L. McCarthy, MD, Department of Pediatrics, Yale School of Medicine, 333 Cedar St, New Haven, CT 06520. E-mail: paul.mccarthy{at}yale.edu
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The Febrile Infant
Pediatrics, 1994Co-Authors: Paul L. MccarthyAbstract:There have now been three large prospective studies of Febrile Infants published within the past 3 years.1-3 Each reports on over 500 patients. Two of the reports, that of Baskin et al1 and that of Jaskiewicz et al,3 in the current issue of Pediatrics, focus on Infants meeting low-risk criteria for serious bacterial illness. These two studies ask the question: "If the Febrile Infant meets these selected low-risk criteria, then with what degree of diagnostic certainty can the examining physician rule out a serious illness?" Statistically, this index of diagnostic certainty is termed negative predictive value. Jaskiewicz et al studied 511 low-risk Febrile Infants and used 437 of these patients to calculate negative predictive value, which was 98.9%.
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Management of the Febrile Infant.
Pediatrics, 1992Co-Authors: Paul L. MccarthyAbstract:In the past 15 years, there has been a geometric increase in the number of studies and commentaries that have focused on the management of the Febrile Infant. This fact is nicely highlighted by the 48 references in Lieu and coworkers9 article in this issue of Pediatrics. Only 5 of the articles appeared prior to 1976, and several of those report on hospitalized Infants in nurseries and not those seen in an outpatient setting. Forty of the references were published in the past 10 years and 15 since 1990. Of interest, two of the largest studies, both of which examined the issues of the efficacy of clinical judgment and screening laboratory tests and challenged, through careful study protocols, the traditional "admit for intravenous antibiotics" dictum which has been applied to most Infants with fever, are now completed and recently published1 or being prepared for publication.2
Thomas B Newman - One of the best experts on this subject based on the ideXlab platform.
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Choice of urine collection methods for the diagnosis of urinary tract infection in young, Febrile Infants
Archives of pediatrics & adolescent medicine, 2005Co-Authors: Alan R. Schroeder, Thomas B Newman, Stacia A Finch, Richard C Wasserman, Robert H PantellAbstract:Background The optimal method of urine collection in Febrile Infants is debatable; catheterization, considered more accurate, is technically difficult and invasive. Objectives To determine predictors of urethral catheterization in Febrile Infants and to compare bag and catheterized urine test performance characteristics. Design Prospective analysis of Infants enrolled in the Pediatric Research in Office Settings’ Febrile Infant Study. Setting A total of 219 practices from within the Pediatric Research in Office Settings’ network, including 44 states, the District of Columbia, and Puerto Rico. Patients A total of 3066 Infants aged 0 to 3 months with temperatures of 38°C or higher. Main Outcome Measures We calculated adjusted odds ratios for predictors of catheterization. Diagnostic test characteristics were compared between bag and catheterization. Urinary tract infection was defined as pure growth of 100 000 CFU/mL or more (bag) and 20 000 CFU/mL or more (catheterization). Results Seventy percent of urine samples were obtained by catheterization. Predictors of catheterization included female sex, practitioner older than 40 years, Medicaid, Hispanic ethnicity, nighttime evaluation, and severe dehydration. For leukocyte esterase levels, bag specimens demonstrated no difference in sensitivity but somewhat lower specificity (84% [bag] vs 94% [catheterization], P P = .01). Infection rates were similar in bag and catheterized specimens (8.5% vs 10.8%). Ambiguous cultures were more common in bag specimens (7.4% vs 2.7%, P Conclusions Most practitioners obtain urine from Febrile Infants via catheterization, but choice of method is not related to the risk of urinary tract infection. Although both urine cultures and urinalyses are more accurate in catheterized specimens, the magnitude of difference is small but should be factored into clinical decision making.
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urine testing and urinary tract infections in Febrile Infants seen in office settings the pediatric research in office settings Febrile Infant study
JAMA Pediatrics, 2002Co-Authors: Thomas B Newman, Jane Bernzweig, John I Takayama, Stacia A Finch, Richard C Wasserman, Robert H PantellAbstract:Objective To determine the predictors and results of urine testing of young Febrile Infants seen in office settings. Design Prospective cohort study. Setting Offices of 573 pediatric practitioners from 219 practices in the American Academy of Pediatrics Pediatric Research in Office Settings' research network. Subjects A total of 3066 Infants 3 months or younger with temperatures of 38°C or higher were evaluated and treated according to the judgment of their practitioners. Main Outcome Measures Urine testing results, early and late urinary tract infections (UTIs), and UTIs with bacteremia. Results Fifty-four percent of the Infants initially had urine tested, of whom 10% had a UTI. The height of the fever was associated with urine testing and a UTI among those tested (adjusted odds ratio per degree Celsius, 2.2 for both). Younger age, ill appearance, and lack of a fever source were associated with urine testing but not with a UTI, whereas lack of circumcision (adjusted odds ratio, 11.6), female sex (adjusted odds ratio, 5.4), and longer duration of fever (adjusted odds ratio, 1.8 for fever lasting ≥24 hours) were not associated with urine testing but were associated with a UTI. Bacteremia accompanied the UTI in 10% of the patients, including 17% of those younger than 1 month. Among 807 Infants not initially tested or treated with antibiotics, only 2 had a subsequent documented UTI; both did well. Conclusions Practitioners order urine tests selectively, focusing on younger and more ill-appearing Infants and on those without an apparent fever source. Such selective urine testing, with close follow-up, was associated with few late UTIs in this large study. Urine testing should focus particularly on uncircumcised boys, girls, the youngest and sickest Infants, and those with persistent fever.
Richard C Wasserman - One of the best experts on this subject based on the ideXlab platform.
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Choice of urine collection methods for the diagnosis of urinary tract infection in young, Febrile Infants
Archives of pediatrics & adolescent medicine, 2005Co-Authors: Alan R. Schroeder, Thomas B Newman, Stacia A Finch, Richard C Wasserman, Robert H PantellAbstract:Background The optimal method of urine collection in Febrile Infants is debatable; catheterization, considered more accurate, is technically difficult and invasive. Objectives To determine predictors of urethral catheterization in Febrile Infants and to compare bag and catheterized urine test performance characteristics. Design Prospective analysis of Infants enrolled in the Pediatric Research in Office Settings’ Febrile Infant Study. Setting A total of 219 practices from within the Pediatric Research in Office Settings’ network, including 44 states, the District of Columbia, and Puerto Rico. Patients A total of 3066 Infants aged 0 to 3 months with temperatures of 38°C or higher. Main Outcome Measures We calculated adjusted odds ratios for predictors of catheterization. Diagnostic test characteristics were compared between bag and catheterization. Urinary tract infection was defined as pure growth of 100 000 CFU/mL or more (bag) and 20 000 CFU/mL or more (catheterization). Results Seventy percent of urine samples were obtained by catheterization. Predictors of catheterization included female sex, practitioner older than 40 years, Medicaid, Hispanic ethnicity, nighttime evaluation, and severe dehydration. For leukocyte esterase levels, bag specimens demonstrated no difference in sensitivity but somewhat lower specificity (84% [bag] vs 94% [catheterization], P P = .01). Infection rates were similar in bag and catheterized specimens (8.5% vs 10.8%). Ambiguous cultures were more common in bag specimens (7.4% vs 2.7%, P Conclusions Most practitioners obtain urine from Febrile Infants via catheterization, but choice of method is not related to the risk of urinary tract infection. Although both urine cultures and urinalyses are more accurate in catheterized specimens, the magnitude of difference is small but should be factored into clinical decision making.
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urine testing and urinary tract infections in Febrile Infants seen in office settings the pediatric research in office settings Febrile Infant study
JAMA Pediatrics, 2002Co-Authors: Thomas B Newman, Jane Bernzweig, John I Takayama, Stacia A Finch, Richard C Wasserman, Robert H PantellAbstract:Objective To determine the predictors and results of urine testing of young Febrile Infants seen in office settings. Design Prospective cohort study. Setting Offices of 573 pediatric practitioners from 219 practices in the American Academy of Pediatrics Pediatric Research in Office Settings' research network. Subjects A total of 3066 Infants 3 months or younger with temperatures of 38°C or higher were evaluated and treated according to the judgment of their practitioners. Main Outcome Measures Urine testing results, early and late urinary tract infections (UTIs), and UTIs with bacteremia. Results Fifty-four percent of the Infants initially had urine tested, of whom 10% had a UTI. The height of the fever was associated with urine testing and a UTI among those tested (adjusted odds ratio per degree Celsius, 2.2 for both). Younger age, ill appearance, and lack of a fever source were associated with urine testing but not with a UTI, whereas lack of circumcision (adjusted odds ratio, 11.6), female sex (adjusted odds ratio, 5.4), and longer duration of fever (adjusted odds ratio, 1.8 for fever lasting ≥24 hours) were not associated with urine testing but were associated with a UTI. Bacteremia accompanied the UTI in 10% of the patients, including 17% of those younger than 1 month. Among 807 Infants not initially tested or treated with antibiotics, only 2 had a subsequent documented UTI; both did well. Conclusions Practitioners order urine tests selectively, focusing on younger and more ill-appearing Infants and on those without an apparent fever source. Such selective urine testing, with close follow-up, was associated with few late UTIs in this large study. Urine testing should focus particularly on uncircumcised boys, girls, the youngest and sickest Infants, and those with persistent fever.
Stacia A Finch - One of the best experts on this subject based on the ideXlab platform.
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Choice of urine collection methods for the diagnosis of urinary tract infection in young, Febrile Infants
Archives of pediatrics & adolescent medicine, 2005Co-Authors: Alan R. Schroeder, Thomas B Newman, Stacia A Finch, Richard C Wasserman, Robert H PantellAbstract:Background The optimal method of urine collection in Febrile Infants is debatable; catheterization, considered more accurate, is technically difficult and invasive. Objectives To determine predictors of urethral catheterization in Febrile Infants and to compare bag and catheterized urine test performance characteristics. Design Prospective analysis of Infants enrolled in the Pediatric Research in Office Settings’ Febrile Infant Study. Setting A total of 219 practices from within the Pediatric Research in Office Settings’ network, including 44 states, the District of Columbia, and Puerto Rico. Patients A total of 3066 Infants aged 0 to 3 months with temperatures of 38°C or higher. Main Outcome Measures We calculated adjusted odds ratios for predictors of catheterization. Diagnostic test characteristics were compared between bag and catheterization. Urinary tract infection was defined as pure growth of 100 000 CFU/mL or more (bag) and 20 000 CFU/mL or more (catheterization). Results Seventy percent of urine samples were obtained by catheterization. Predictors of catheterization included female sex, practitioner older than 40 years, Medicaid, Hispanic ethnicity, nighttime evaluation, and severe dehydration. For leukocyte esterase levels, bag specimens demonstrated no difference in sensitivity but somewhat lower specificity (84% [bag] vs 94% [catheterization], P P = .01). Infection rates were similar in bag and catheterized specimens (8.5% vs 10.8%). Ambiguous cultures were more common in bag specimens (7.4% vs 2.7%, P Conclusions Most practitioners obtain urine from Febrile Infants via catheterization, but choice of method is not related to the risk of urinary tract infection. Although both urine cultures and urinalyses are more accurate in catheterized specimens, the magnitude of difference is small but should be factored into clinical decision making.
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urine testing and urinary tract infections in Febrile Infants seen in office settings the pediatric research in office settings Febrile Infant study
JAMA Pediatrics, 2002Co-Authors: Thomas B Newman, Jane Bernzweig, John I Takayama, Stacia A Finch, Richard C Wasserman, Robert H PantellAbstract:Objective To determine the predictors and results of urine testing of young Febrile Infants seen in office settings. Design Prospective cohort study. Setting Offices of 573 pediatric practitioners from 219 practices in the American Academy of Pediatrics Pediatric Research in Office Settings' research network. Subjects A total of 3066 Infants 3 months or younger with temperatures of 38°C or higher were evaluated and treated according to the judgment of their practitioners. Main Outcome Measures Urine testing results, early and late urinary tract infections (UTIs), and UTIs with bacteremia. Results Fifty-four percent of the Infants initially had urine tested, of whom 10% had a UTI. The height of the fever was associated with urine testing and a UTI among those tested (adjusted odds ratio per degree Celsius, 2.2 for both). Younger age, ill appearance, and lack of a fever source were associated with urine testing but not with a UTI, whereas lack of circumcision (adjusted odds ratio, 11.6), female sex (adjusted odds ratio, 5.4), and longer duration of fever (adjusted odds ratio, 1.8 for fever lasting ≥24 hours) were not associated with urine testing but were associated with a UTI. Bacteremia accompanied the UTI in 10% of the patients, including 17% of those younger than 1 month. Among 807 Infants not initially tested or treated with antibiotics, only 2 had a subsequent documented UTI; both did well. Conclusions Practitioners order urine tests selectively, focusing on younger and more ill-appearing Infants and on those without an apparent fever source. Such selective urine testing, with close follow-up, was associated with few late UTIs in this large study. Urine testing should focus particularly on uncircumcised boys, girls, the youngest and sickest Infants, and those with persistent fever.
