You are seeing a 15 month old female with 36 hours of fever, current temp in ED 38.9 rectal (last antipyretic 6 hours prior), no other symptoms, well-appearing, no past medical history. Which would you do?
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You are seeing a 15 month old female with 36 hours of fever, current temp in ED 38.9 rectal (last antipyretic 6 hours prior), no other symptoms, well-appearing, no past medical history. Which would you do?
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August 10, 2016 at 9:24 pm
Interesting… the answers are spreading out. This question was sparked in part by Moh bringing to our attention this article: http://www.ncbi.nlm.nih.gov/pubmed/27255151 which reduced cath UA’s by screening first with bag UA’s. So one question is whether bag UA is considered a useful first step screen. It was also sparked by Josh reading this great analysis on first10EM: https://first10em.com/2016/02/02/pediatric-uti/ which raises the question are we getting too many UAs in the first place? The old fever w/o source recommendations were to get UA in temp 39+ in <24 mo old (I made the case temp 38.9 on purpose). But even with higher temp, there is a case to be made against routine UA at all.
August 24, 2016 at 10:18 am
Our new protocol in the ER is : not UA before 72h of fever for children of 3 months and older.
No UA for boys of more than 1year and girls of more than 2 years. Unless… they have ATCD of pyelonephritis or urologic abnormality/surgery.
August 24, 2016 at 10:53 am
That sounds like a reasonable approach! Parents bring in their kids with just 24 hours of fever so often – if they went to a general pediatrician’s office they would probably not get a UA. Personally, I might move the age up to 6 months, but that would be a minor change, and it’s mainly because my patient population doesn’t have good follow-up and often has transportation issues to return to ED.
September 14, 2016 at 1:01 am
Oh-oh – new literature muddying things up a bit. http://www.ncbi.nlm.nih.gov/pubmed/27455161 They found on 2 year follow-up of 482 < 6 year olds with UTI that 7.2% developed renal scarring and delay in antibiotic treatment was associated with increased risk of renal scarring.