Welcome to the Emergency Medicine Cases podcast.

I'm your host, Dr. Anton Hellman, bringing you Canada's brightest minds in emergency medicine from EMC Studios in Toronto.

Okay, let's cut to the chase.

Pediatric UTI.

It isn't earth-shattering emergency medicine.

It isn't thoracotomy.

It isn't ECMO in the Paris subway system.

Look it up.

And it isn't the fine touch of delayed sequence intubation.

But I'm here to tell you that it's A important, B, common, and C, generally done well, not that well.

On the one hand, UTI is one of the most common bacterial infections in children younger than two years of age,

and theoretically at least, could maybe lead to sepsis acutely and renal failure in the long run. Again, maybe.

On the other hand, it's important not to overdiagnose UTIs because we know that overuse of antibiotics

increases costs, side effects, and leads to antibiotic resistance. So how does a humble emergency

doctor navigate the waters?

The first principles questions very much apply here. Who to screen? How to screen? What to do with

the screen results? And the risks associated with not having a standardized approach

to diagnosing pediatric UTIs. I'd like to kickstart a discussion by outlining an argument that was published in the

annals of EM about six years ago in a paper entitled, Pediatric Urinary Tract Infection,

does the evidence support aggressively pursuing the diagnosis?

And the argument goes like this.

There's a substantial amount of overlap between a true

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