Pathway for the Evaluation and Treatment of Children with Febrile UTI

History and Physical Examination

History Duration of fever
Symptoms that suggest an alternative source of fever
Hydration status
History of recurring fever without identifiable source
History of UTI
History of constipation
Dysfunctional voiding by history
FH of vesicoureteral reflux (VUR) or renal disease
Physical Examination VS, consider BP, growth
Suprapubic, flank tenderness
Abdominal mass, palpable bladder
Evidence of spinal lesion
Other GU abnormality
Age Group Symptoms and Signs of UTI: Most Common to Least Common
>56 days – 18 years Preverbal Fever Abdominal pain
Vomiting
Poor feeding
Flank pain / tenderness
Lethargy
Irritability
Hematuria
Malodorous urine
Failure to thrive
Verbal Frequency
Dysuria
Hesitancy
Urgency
Incontinence
Abdominal pain
Flank pain / tenderness
Fever
Malaise
Nausea
Vomiting
Hematuria
Malodorous urine
Cloudy urine

Source of Fever

Definite (screen per clinical indications) Potential (screen per recommendations)
Bacterial Meningitis
Pneumonia
Strep pharyngitis
Purulent OM
Bronchiolitis
Varicella
Coxsackie
Kawasaki Disease
Gastroenteritis
URI
Otitis media
Non-specific rash