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Lautin, E M; Novick, M K; Jean-Baptiste, R.

Br J Radiol ; 81(966): 442-3, 2008 Jun.

Artículo en Inglés | MEDLINE | ID: mdl-18347029

RESUMEN

Despite its vital diagnostic utility, the ionizing radiation used in CT is not benign. Patients have an increased risk of dying from a radiation-induced cancer for every pass through a CT scanner. One way to reduce this risk is to tailor CT, especially follow-up scans, to specific areas of concern. By doing so, we can help to minimize the small but real risk from this essential technology.

Asunto(s)

Neoplasias Inducidas por Radiación/etiología , Tomografía Computarizada por Rayos X/efectos adversos , Humanos , Factores de Riesgo , Conducta de Reducción del Riesgo

Test characteristics of the urine Gram stain in infants

Dayan, P S; Bennett, J; Best, R; Bregstein, J S; Levine, D; Novick, M K; Sonnett, F M; Stimell-Rauch, M L; Urtecho, J; Wagh, A; Miller, S Z.

Pediatr Emerg Care ; 18(1): 12-4, 2002 Feb.

Artículo en Inglés | MEDLINE | ID: mdl-11862130

RESUMEN

OBJECTIVE: The utility of the Gram stain for the preliminary diagnosis of urinary tract infections (UTI) in infants or= 38.0 degrees C presenting to a pediatric emergency department during 2 consecutive winter seasons. Single pathogen growth of >or= 10(4) cfu/mL from a catheterized specimen and >or= 10(3) cfu/mL from a suprapubic specimen was considered positive. A positive Gram stain was defined as the identification of any organisms. Urinalysis was tested for the presence of nitrites and for leukocyte esterase (LE). Urine microscopy was analyzed for white blood cells per high power field (WBC/hpf). RESULTS: Fourteen of 246 patients were excluded; 11 because no Gram stain was completed. Of the remaining 232 patients, Gram stain had a sensitivity of 85.2% (95% CI 71.9-98.6%), a specificity of 99.0% (95% CI 97.7-100%), a likelihood ratio for a positive test of 87.3 (95% CI 21.8-349.9), and a likelihood ratio for a negative test of 0.15 (95% CI 0.06-0.37). There were 193 specimens for which a Gram stain and a complete UA and microscopy were completed and compared. Urine microscopy had a lower sensitivity and specificity than Gram stain for both >or= 5 WBC/hpf and >or= 10 WBC/hpf. In addition to the Gram stain, a dipstick negative for nitrites and LE had a low negative likelihood ratio (0.16), useful for decreasing the likelihood of a UTI. CONCLUSIONS: The Gram stain has excellent test characteristics for the preliminary diagnosis of a UTI in febrile infants. Patient disposition and therapy will likely change if clinical protocols and guidelines use the Gram stain rather than urine microscopy for preliminary diagnosis of UTI in infants.

Asunto(s)

Violeta de Genciana , Fenazinas , Infecciones Urinarias/diagnóstico , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Microscopía , Estudios Prospectivos , Sensibilidad y Especificidad , Urinálisis , Infecciones Urinarias/microbiología , Infecciones Urinarias/orina

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