While I agree with you that CCU have a role, especially in the "low risk"
infant, the study data you have presented cannot be generalized to the
population presenting to the average pediatric emergency department
1. The prevalence of UTI in your study is 31 %. The prevalence in the
average febrile infant population presenting to the ED is any where from
5-12% depending on whom you read. This would lower the specificity of a CCU.
False positives (1- specificity) would be proportionately higher.
2. One has to be concerned about selection bias because of differential
surveillance. Study patients may have had rigorous perineal hygiene by the
nurses or investigators.
3. The clinical scenarios that warranted a UC on these patients are not
defined or standardized. In other words, inclusion criteria including age &
sex of the patients were not delineated. Were these well appearing febrile
male infants without source or were they also those who may have had UTI
before, had a sibling with VUR or presented with a parent complaining of a
foul smelling urine etc?? How many of them were neonates?
4. 48% of the patients required an average of 4 hours before a urine for CCU
was obtained. This would be an inordinately long time in a busy ED setting.
Combined with the risk of recall & repeat collections due to false
positives my inkling is it would not be cost effective.
Cheers. BTW, are you having to walk to work with all the fuel shortage in
Jay Pershad, MD
Pediatric Emergency Specialists, PC
LeBonheur Children's Medical Center
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