Retrospective Analysis of Genitourinary Complaints in Pediatric Males Presenting to the Emergency Department

OBJECTIVES: Hemorrhagic urinary tract infections (UTIs) are rare among healthy young males, and these infections lack epidemiological data as well as a standardized approach in the emergency department (ED). The purpose of this study was to investigate the presentation of healthy pediatric males presenting to the ED with features associated with hematuria and UTIs. METHODS: We performed a retrospective chart review of male patients aged 1 to 8 years presenting to a single pediatric ED from January 2016 to December 2022 with ICD-10 codes related to UTI and hematuria. Demographic and clinical data were collected, and multivariable regressions were performed with subgroup comparisons by gross hematuria and age. RESULTS: Of 634 included male patients, 213 (34%) had gross hematuria. These children were older (P < 0.0001) and had lower rates of confirmed UTI (P = 0.002). Urine cultures most commonly grew Escherichia coli and Proteus mirabilis, with age-specific differences in isolated organisms. Gross hematuria was independently associated with lower odds of UTI after adjustment for age, circumcision status, and presenting symptoms (OR: 0.49, CI: 0.29-0.82; P = 0.007). In a subgroup analysis of children with gross hematuria, older age (5 to 8 y) was associated with decreased odds of UTI (OR: 0.77, CI: 0.61-0.97; P = 0.02). CONCLUSION: Within this ICD-defined cohort, gross hematuria was associated with lower odds of confirmed UTI, with odds decreasing with increasing age. These findings suggest that gross hematuria alone may be a poor predictor of UTI and should be interpreted with caution when considering empiric antibiotic treatment, highlighting the importance of antibiotic stewardship in the ED.