FEVER IN THE CLINICAL-DIAGNOSIS OF ACUTE PYELONEPHRITIS

Acute pyelonephritis is a clinical syndrome that can be confused with other conditions. To investigate this problem, a retrospective cohort study was conducted using two mutually exclusive sets of clinical crit eria for acute pyelonephritis in women 15 years of age or older who pr esented to the emergency department of a university hospital, All pati ents had pyuria, and one group had documented fever (temperature of gr eater than or equal to 37.8 degrees C) while the other group had a tem perature of <37.8 degrees C but had other evidence of possible upper t ract infection, The study cohort was comprised of 103 febrile and 201 afebrile patients, Afebrile hospitalized patients were ultimately foun d to have another diagnosis more often than were the febrile hospitali zed patients (35% v 7%; P=.02), and the afebrile nonhospitalized patie nts were more likely to have another diagnosis than were the febrile n onhospitalized patients (13% v 0%; P=.004). Other diagnoses included c holecystitis, pelvic inflammatory disease, and diverticulitis. The pos itive predictive value of the definition of pyelonephritis in the febr ile group was 0.98, and it was 0.84 for the afebrile group, Physicians examining patients with clinical evidence of acute pyelonephritis but without objective fever should be alert for alternative diagnoses. Co pyright (C) 1997 by W.B. Saunders Company.