The Experts below are selected from a list of 12873 Experts worldwide ranked by ideXlab platform
Denise M Malicki - One of the best experts on this subject based on the ideXlab platform.
-
automated Urinalysis and urine dipstick in the emergency evaluation of young febrile children
Pediatrics, 2014Co-Authors: Joh T Kanegaye, Jennife M Jacob, Denise M MalickiAbstract:OBJECTIVE: The performance of automated flow cytometric Urinalysis is not well described in pediatric urinary tract infection. We sought to determine the diagnostic performance of automated cell counts and emergency department point-of-care (POC) dipstick urinalyses in the evaluation of young febrile children. METHODS: We prospectively identified a convenience sample of febrile pediatric emergency department patients <48 months of age who underwent urethral catheterization to obtain POC and automated urinalyses and urine culture. Receiver operating characteristic analyses were performed and diagnostic indices were calculated for POC dipstick and automated cell counts at different cutpoints. RESULTS: Of 342 eligible children, 42 (12%) had urinary bacterial growth ≥50 000/mL. The areas under the receiver operating characteristic curves were: automated white blood cell count, 0.97; automated bacterial count, 0.998; POC leukocyte esterase, 0.94; and POC nitrite, 0.76. Sensitivities and specificities were 86% and 98% for automated leukocyte counts ≥100/μL and 98% and 98% for bacterial counts ≥250/μL. POC urine dipstick with ≥1+ leukocyte esterase or positive nitrite had a sensitivity of 95% and a specificity of 98%. Combinations of white blood cell and bacterial counts did not outperform bacterial counts alone. CONCLUSIONS: Automated leukocyte and bacterial counts performed well in the diagnosis of urinary tract infection in these febrile pediatric patients, but POC dipstick may be an acceptable alternative in clinical settings that require rapid decision-making.
Ellen R Wald - One of the best experts on this subject based on the ideXlab platform.
-
enhanced Urinalysis improves identification of febrile infants ages 60 days and younger at low risk for serious bacterial illness
Pediatrics, 2001Co-Authors: Sandra Herr, Ellen R Wald, Raymond D Pitetti, Sylvia S ChoiAbstract:Objective. Investigators have sought to establish “low-risk” criteria to identify febrile young infants who can be observed safely without antibiotics. Previous studies have used criteria for standard Urinalysis to identify suspected urinary tract infection; however, cases of urinary tract infection have been missed. Enhanced Urinalysis, using hemocytometer cell count and Gram stain performed on uncentrifuged urine, has been shown to have greater sensitivity and negative predictive value than standard Urinalysis. The objective of this study was to evaluate the ability of criteria that incorporate enhanced Urinalysis to identify febrile young infants who are at low risk for serious bacterial illness (SBI). Methods. Institutional guidelines were established in 1999 to evaluate in a retrospective cohort study infants who were ≤60 days of age with temperature ≥38.0°C. “Low-risk” criteria included 1) well appearance without focal infection (excluding otitis media); 2) no history of prematurity, illness, or previous antibiotics; 3) peripheral white blood cell count (WBC) between 5 and 15 000/mm3; 4) absolute band count ≤1500/mm3; 5) cerebrospinal fluid WBC ≤5/mm3 with a negative Gram stain; 6) enhanced Urinalysis with WBC ≤9/mm3 with a negative Gram stain; 7) stool WBC Results. During the study period, 434 infants presented to the emergency department for evaluation of fever. Thirty patients were excluded from additional analysis because of incomplete data; 60 patients were identified immediately as “not low risk” on the basis of history or physical examination. Of the 344 remaining infants, 127 were identified as “low risk” on the basis of laboratory criteria; 83 (65.4%) were observed without antibiotics. None of the “low-risk” infants had an SBI. A total of 217 well-appearing infants were classified as “not low risk” on the basis of laboratory criteria; 28 (12.9%) had an SBI. The overall incidence of SBI in infants with complete data was 10.1%, whereas the incidence of SBI in all “not low-risk” infants was 14.8%. The negative predictive value for the “Pittsburgh” criteria was 100% (95% confidence interval: 96.7%–100%); the sensitivity was 100% (95% confidence interval: 89.7%–100%). Conclusions. The application of low-risk criteria using enhanced Urinalysis improves identification of infants who are at low risk for SBI.
-
is urine culture necessary to rule out urinary tract infection in young febrile children
Pediatric Infectious Disease Journal, 1996Co-Authors: Alejandro Hoberman, Ellen A Reynolds, Lila Penchansky, Ellen R Wald, Martin CharronAbstract:ObjectiveTo determine whether the absence of pyuria on the enhanced Urinalysis can be used to eliminate the diagnosis of urinary tract infection, avoiding the need for urine culture and sparing large health care expenditures.DesignResults of an enhanced Urinalysis (hemocytometer counts and interpret
-
enhanced Urinalysis as a screening test for urinary tract infection
Pediatrics, 1993Co-Authors: Alejandro Hoberman, Ellen A Reynolds, Lila Penchansky, Ellen R Wald, Stacey YoungAbstract:Urinary tract infection (UTI) is a common and important clinical problem in infants and young children. UTI is often suspected on the basis of results of microscopic Urinalysis; accordingly, it is important that its results be as reproducible, accurate, and easily interpretable as possible. A positive Urinalysis allows early detection and treatment of UTI, while a negative Urinalysis can potentially eliminate the cost of expensive hospitalization for intravenous administration of antibiotics, the current standard treatment of UTI in young febrile children. In pediatric primary care facilities, microscopic Urinalysis often is performed using centrifuged urine and reported as the number of white blood cells (WBCs) or bacteria per high-power microscopic field (hpf).
Alejandro Hoberman - One of the best experts on this subject based on the ideXlab platform.
-
is urine culture necessary to rule out urinary tract infection in young febrile children
Pediatric Infectious Disease Journal, 1996Co-Authors: Alejandro Hoberman, Ellen A Reynolds, Lila Penchansky, Ellen R Wald, Martin CharronAbstract:ObjectiveTo determine whether the absence of pyuria on the enhanced Urinalysis can be used to eliminate the diagnosis of urinary tract infection, avoiding the need for urine culture and sparing large health care expenditures.DesignResults of an enhanced Urinalysis (hemocytometer counts and interpret
-
enhanced Urinalysis as a screening test for urinary tract infection
Pediatrics, 1993Co-Authors: Alejandro Hoberman, Ellen A Reynolds, Lila Penchansky, Ellen R Wald, Stacey YoungAbstract:Urinary tract infection (UTI) is a common and important clinical problem in infants and young children. UTI is often suspected on the basis of results of microscopic Urinalysis; accordingly, it is important that its results be as reproducible, accurate, and easily interpretable as possible. A positive Urinalysis allows early detection and treatment of UTI, while a negative Urinalysis can potentially eliminate the cost of expensive hospitalization for intravenous administration of antibiotics, the current standard treatment of UTI in young febrile children. In pediatric primary care facilities, microscopic Urinalysis often is performed using centrifuged urine and reported as the number of white blood cells (WBCs) or bacteria per high-power microscopic field (hpf).
Lise E Nigrovic - One of the best experts on this subject based on the ideXlab platform.
-
febrile infants 60 days old with positive Urinalysis results and invasive bacterial infections
Hospital pediatrics, 2020Co-Authors: Lyubina C Yankova, Mark I Neuman, Marie E Wang, Christopher Woll, Adrienne G Deporre, Sanyukta Desai, Laura F Sartori, Lise E NigrovicAbstract:OBJECTIVES: We aimed to describe the clinical and laboratory characteristics of febrile infants ≤60 days old with positive Urinalysis results and invasive bacterial infections (IBI). METHODS: We performed a planned secondary analysis of a retrospective cohort study of febrile infants ≤60 days old with IBI who presented to 11 emergency departments from July 1, 2011, to June 30, 2016. For this subanalysis, we included infants with IBI and positive Urinalysis results. We analyzed the sensitivity of high-risk past medical history (PMH) (prematurity, chronic medical condition, or recent antimicrobial receipt), ill appearance, and/or abnormal white blood cell (WBC) count ( 15 000 cells/μL) for identification of IBI. RESULTS: Of 148 febrile infants with positive Urinalysis results and IBI, 134 (90.5%) had bacteremia without meningitis and 14 (9.5%) had bacterial meningitis (11 with concomitant bacteremia). Thirty-five infants (23.6%) with positive Urinalysis results and IBI did not have urinary tract infections. The presence of high-risk PMH, ill appearance, and/or abnormal WBC count had a sensitivity of 53.4% (95% confidence interval: 45.0–61.6) for identification of IBI. Of the 14 infants with positive Urinalysis results and concomitant bacterial meningitis, 7 were 29 to 60 days old. Six of these 7 infants were ill-appearing or had an abnormal WBC count. The other infant had bacteremia with cerebrospinal fluid pleocytosis after antimicrobial pretreatment and was treated for meningitis. CONCLUSIONS: The sensitivity of high-risk PMH, ill appearance, and/or abnormal WBC count is suboptimal for identifying febrile infants with positive Urinalysis results at low risk for IBI. Most infants with positive Urinalysis results and bacterial meningitis are ≤28 days old, ill-appearing, or have an abnormal WBC count.
Lila Penchansky - One of the best experts on this subject based on the ideXlab platform.
-
is urine culture necessary to rule out urinary tract infection in young febrile children
Pediatric Infectious Disease Journal, 1996Co-Authors: Alejandro Hoberman, Ellen A Reynolds, Lila Penchansky, Ellen R Wald, Martin CharronAbstract:ObjectiveTo determine whether the absence of pyuria on the enhanced Urinalysis can be used to eliminate the diagnosis of urinary tract infection, avoiding the need for urine culture and sparing large health care expenditures.DesignResults of an enhanced Urinalysis (hemocytometer counts and interpret
-
enhanced Urinalysis as a screening test for urinary tract infection
Pediatrics, 1993Co-Authors: Alejandro Hoberman, Ellen A Reynolds, Lila Penchansky, Ellen R Wald, Stacey YoungAbstract:Urinary tract infection (UTI) is a common and important clinical problem in infants and young children. UTI is often suspected on the basis of results of microscopic Urinalysis; accordingly, it is important that its results be as reproducible, accurate, and easily interpretable as possible. A positive Urinalysis allows early detection and treatment of UTI, while a negative Urinalysis can potentially eliminate the cost of expensive hospitalization for intravenous administration of antibiotics, the current standard treatment of UTI in young febrile children. In pediatric primary care facilities, microscopic Urinalysis often is performed using centrifuged urine and reported as the number of white blood cells (WBCs) or bacteria per high-power microscopic field (hpf).