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To develop a clinical prediction rule to identify febrile young girls needing urine culture for evaluation of urinary tract infection (UTI).

Prospective cohort study.

Urban children's hospital emergency department.

All girls younger than 2 years (N=1469) presenting to the emergency department with fever (temperature ≥38.3°C) and without an unequivocal source of fever during a 12-month period.

The outcome of interest was UTI, defined as a catheterized urine culture with pure growth of 10⁴colonies/mL or greater. Candidate predictors included demographic, historical, and physical examination variables. Clinical prediction rules were developed using multiple logistic regression after screening variables for univariate association and reliability.

The presence of 2 or more of the following 5 variables—less than 12 months old, white race, temperature of 39.0°C …