Diagnostic performance of urine dipstick testing in children with suspected UTI: a systematic review of relationship with age and comparison with microscopy

Mori, Rintaro; Yonemoto, Naohiro; Fitzgerald, A; Tullus, Kjell; Verrier‐Jones, Kate; Lakhanpaul, Monica

doi:10.1111/j.1651-2227.2009.01644.x

Cited by 85 publications

(60 citation statements)

References 15 publications

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“…When strict criteria were applied for patient enrollment and urine collection, the diagnostic performance of conventional rapid urine tests in our study was remarkable compared to that previously reported [14,19]. Nevertheless, the finding that a number of children were misclassified and unnecessary treated with antibiotic therapy due to false positive rapid urine tests emphasized the need for a rapid assay with better accuracy.…”

Section: Discussioncontrasting

confidence: 63%

“…A recent study showed that urine HBP (UHBP) provided better sensitivity and specificity compared to urine dipstick analysis in children with upper or lower urinary tract infection (UTI) [8]. As some reports demonstrated that urine microscopy had better accuracy than dipstick analysis in young children [14,12], the diagnostic performance of UHBP in comparison to urine microscopy is of paramount interest and has yet to be determined.…”

Section: Introductionmentioning

confidence: 98%

“…Since clinical signs of pediatric APN are heterogeneous and nonspecific [6,13], conventional rapid urine assays, e.g., dipstick analysis or microscopy, are the main diagnostic tool despite the wide variation of reported accuracy ranging from 10 to 100 % [14,19,7,16]. The need for a better rapid diagnostic test is apparent and prominent in hospitalized children with presumed APN where broad-spectrum cephalosporins are usually prescribed until urine culture results are available [11].…”

Section: Introductionmentioning

confidence: 98%

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Diagnostic accuracy of urine heparin binding protein for pediatric acute pyelonephritis

Lertdumrongluk

Thongmee

Kerr³

et al. 2014

Eur J Pediatr

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Section: Discussioncontrasting

confidence: 63%

Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 98%

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Diagnostic accuracy of urine heparin binding protein for pediatric acute pyelonephritis

Lertdumrongluk

Thongmee

Kerr³

et al. 2014

Eur J Pediatr

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“…If however the patient with symptoms of UTI is not severely sick, a urine sample can be obtained by the most convenient method (for example adhesive urine bag) and sent for urinalysis and microscopy. If this urine sample is negative for leukocyte and nitrites, the likelihood of UTI is low (Mori et al 2010;Ramlakhan et al 2011); if however leucocytes and/nitrites are detected, a second urine sample should be obtained by a bladder catheter or SPA and sent for urine culture.…”

Section: Diagnosismentioning

confidence: 99%

Febrile Urinary Tract Infections in Children Less Than 2 Years of Age

Geier¹,

Feber²

2012

Evolving Trends in Urology

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“…12 Dipstick has been shown to perform well in children $2 years old as a screening test for UTI. 13 Microscopic examination of urine requires technicians with special training in laboratories using CLIA-certified methods. 12 Previous studies have questioned the additional benefit of microscopy over dipstick urinalysis in children; however, these studies included few infants 1 to 90 days of age.…”

mentioning

confidence: 99%

Dipstick Screening for Urinary Tract Infection in Febrile Infants

2014

PEDIATRICS

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WHAT'S KNOWN ON THIS SUBJECT: Urinary tract infection (UTI) is the most common bacterial infection in febrile infants aged 1 to 90 days. It is unclear if urine microscopy offers significant benefit beyond urine dipstick as a screening test for UTI in this population.WHAT THIS STUDY ADDS: Dipstick may be an adequate screening test for UTI in infants aged 1 to 90 days with a negative predictive value (NPV) of 98.7%. Adding microscopy increases the NPV to 99.2% but results in 8 false-positives for every UTI missed by dipstick.abstract OBJECTIVE: This study compares the performance of urine dipstick alone with urine microscopy and with both tests combined as a screen for urinary tract infection (UTI) in febrile infants aged 1 to 90 days. METHODS:We queried the Intermountain Healthcare data warehouse to identify febrile infants with urine dipstick, microscopy, and culture performed between 2004 and 2011. UTI was defined as .50 000 colonyforming units per milliliter of a urinary pathogen. We compared the performance of urine dipstick with unstained microscopy or both tests combined ("combined urinalysis") to identify UTI in infants aged 1 to 90 days. RESULTS:Of 13 030 febrile infants identified, 6394 (49%) had all tests performed and were included in the analysis. Of these, 770 (12%) had UTI. Urine culture results were positive within 24 hours in 83% of UTIs. The negative predictive value (NPV) was .98% for all tests. The combined urinalysis NPV was 99.2% (95% confidence interval: 99.1%-99.3%) and was significantly greater than the dipstick NPV of 98.7% (98.6%-98.8%). The dipstick positive predictive value was significantly greater than combined urinalysis (66.8% [66.2%-67.4%] vs 51.2% [50.6%-51.8%]). These data suggest 8 febrile infants would be predicted to have a false-positive combined urinalysis for every 1 infant with UTI initially missed by dipstick screening.CONCLUSIONS: Urine dipstick testing compares favorably with both microscopy and combined urinalysis in febrile infants aged 1 to 90 days. The urine dipstick test may be an adequate stand-alone screen for UTI in febrile infants while awaiting urine culture results.

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Diagnostic performance of urine dipstick testing in children with suspected UTI: a systematic review of relationship with age and comparison with microscopy

Abstract: Urine dipstick testing is more effective for diagnosis of UTI in children over 2 years than for younger children.

Cited by 85 publications

References 15 publications

Diagnostic accuracy of urine heparin binding protein for pediatric acute pyelonephritis

Diagnostic accuracy of urine heparin binding protein for pediatric acute pyelonephritis

Febrile Urinary Tract Infections in Children Less Than 2 Years of Age

Dipstick Screening for Urinary Tract Infection in Febrile Infants

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