Shaikh Nader, Morone Natalia E, Lopez John, Chianese Jennifer, Sangvai Shilpa, D'Amico Frank, Hoberman Alejandro, Wald Ellen R
Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
JAMA. 2007 Dec 26;298(24):2895-904. doi: 10.1001/jama.298.24.2895.
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.
To review the diagnostic accuracy of symptoms and signs for the diagnosis of UTI in infants and children.
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.
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.
Two evaluators independently reviewed, rated, and abstracted data from each article.
In infants with fever, history of a previous UTI (likelihood ratio [LR] range, 2.3-2.9), temperature higher than 40 degrees 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 <39 degrees C with another source for fever, the LR was 0.37; 95% CI, 0.16-0.85). In verbal children, abdominal pain (LR, 6.3; 95% CI, 2.5-16.0), back pain (LR, 3.6; 95% CI, 2.1-6.1), dysuria, frequency, or both (LR range, 2.2-2.8), and new-onset urinary incontinence (LR, 4.6; 95% CI, 2.8-7.6) increased the likelihood of a UTI.
Although individual signs and symptoms were helpful in the diagnosis of a UTI, they were not sufficiently accurate to definitively diagnose UTIs. Combination of findings can identify infants with a low likelihood of a UTI.
尿路感染（UTI）是一种常见的儿科疾病，若不治疗可导致永久性肾损伤。因此，准确诊断UTI很重要。
综述症状和体征对婴幼儿及儿童UTI诊断的准确性。
检索MEDLINE和EMBASE数据库中1966年至2007年10月发表的文章，并人工查阅所有符合纳入标准文章的参考文献、1篇先前发表的系统评价、3本临床技能教科书以及2位该领域专家的资料，共获得6988篇可能相关的文章。
纳入包含18岁及以下儿童UTI体征或症状数据的研究。在337篇被审查的文章中，12篇符合所有纳入标准。
两名评估者独立审查、评分并提取每篇文章的数据。
对于发热的婴儿，既往UTI病史（似然比[LR]范围为2.3 - 2.9）、体温高于40℃（LR范围为3.2 - 3.3）以及耻骨上压痛（LR为4.4；95%置信区间[CI]为1.6 - 12.4）是最有助于识别UTI患儿的发现。在男婴中，未行包皮环切术增加了UTI的可能性（汇总LR为2.8；95%CI为1.9 - 4.3）；而行包皮环切术是唯一似然比小于0.5的发现（汇总LR为0.33；95%CI为0.18 - 0.63）。在识别UTI患儿方面，多种发现的组合比单一发现更有用（对于体温>39℃持续>48小时且检查时无其他发热潜在原因的情况，所有发现均存在时的LR为4.0；95%CI为1.2 - 13.0；对于体温<39℃且有其他发热原因的情况，LR为0.37；95%CI为0.16 - 0.85）。对于能表达的儿童，腹痛（LR为6.3；95%CI为2.5 - 16.0）、背痛（LR为3.6；95%CI为2.1 - 6.1）、排尿困难、尿频或两者兼有（LR范围为2.2 - 2.8）以及新发尿失禁（LR为4.6；95%CI为2.8 - 7.6）增加了UTI的可能性。
尽管个别体征和症状有助于UTI的诊断，但它们的准确性不足以明确诊断UTI。多种发现的组合可识别UTI可能性较低的婴儿。
