Algorithm for ED Evaluation and Management of Pediatric UTI

When should urinary tract infections (UTI) be included in the differential diagnosis for febrile infants and young children? The EM Committee on Quality Transformation in the American Academy of Pediatrics (AAP) thoughtfully outlines a clinical algorithm to help guide clinicians towards a standardized, evidence-based approach. Thanks to the expert content team (Drs. Shabnam Jain, Anne Stack, Scott Barron, Pradip Chaudhari, and Kathy Shaw) for sharing this clinical algorithm.

Evaluation and Management of Pediatric UTI

AAP Section on EM Committee on Quality Transformation 2018 Algorithm

Additional Pearls

There is a difference between screening for UTI (as in a child with fever without source, which this algorithm is meant for) and testing for UTI (in those with symptoms suggestive of UTI or a prior history)
The “2-step method” mentioned for patients aged 6-24 months involves using a bag specimen or clean catch specimen (including bladder stimulation technique) as the initial step. If the results are positive, obtain urine for culture using catheterization or suprapubic aspiration. This method avoids catheterization if the bag results are negative.
In pediatrics, obtain a urine culture from an adequate specimen before treating for a UTI.

Read other AAP-EM Section guidelines on ALiEM

Author information

Shabnam Jain, MD, MPH

Associate Professor
Departments of Pediatrics and Emergency Medicine
Emory University and Children’s Healthcare of Atlanta

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