Dipstick only urinalysis screen for the pediatric emergency room

Abstract

To determine if microscopic urinalysis is needed in all pediatric emergency room patients screened for urinary tract infections (UTI), we compared the dipstick urinalysis and complete urinalysis (dipstick and microscopy) with urine cultures in 236 children, aged 3 weeks to 21 years. The ability to detect UTI by dipstick only and by complete urinalysis was the same, however microscopic evaluation added many false-positive results without detecting additional UTIs. Because the ability to detect UTI (sensitivity) is maintained, we now offer a dipstick only urinalysis to our emergency room for children 2 years of age or older, with a microscopic analysis performed automatically if dipstick results are positive. If no microscopic urinalysis is required, testing turn-around time is reduced by 12.3 min/test and the hospital charge is reduced from U.S. $32 to U.S. $12.

Clinical effectiveness and cost-effectiveness of tests for the diagnosis and investigation of urinary tract infection in children: a systematic review and economic model

“…45,75,112,232,233 Four studies each evaluated one combination of tests (nitrite, blood or protein positive; 45 nitrite, blood or LE positive; 49 nitrite, blood and LE positive; 52 nitrite, LE or protein positive 112 ) and one combination was evaluated by two studies (nitrite, LE and protein positive). 75,112 Only one study included an appropriate spectrum of patients, and three studies did not adequately describe the criteria used to select patients.…”

“…The plot indicated two apparent outliers. 52,103 These studies did not appear to differ from the other studies in There were insufficient studies to investigate heterogeneity using regression analysis. Six of the eight studies included an appropriate spectrum of patients.…”

“…52,60,[67][68][69]85,102,103 The majority (6/8) of these studies included an appropriate spectrum of patients. However, half of the studies did not adequately report the criteria used to select participants.…”

Can Urine Clarity Exclude the Diagnosis of Urinary Tract Infection?

“…5,10 Many previous studies have examined the utility of urine dipsticks and microscopy in the rapid detection of UTIs in children. [1][2][3][4][5][6] None of these tests have produced a screening study with 100% sensitivity. Therefore, urine cultures are routinely obtained on all specimens.…”

“…Investigators have tried using the urine dipstick, Gram stain, microscopy, and enhanced urinalysis for more rapid diagnosis, but none of these methods were capable of detecting all UTIs. [1][2][3][4][5][6] Because no rapid method can exclude a UTI with 100% certainty, most clinicians send all urine specimens for culture, irrespective of the findings on routine urinalysis.There are 2 studies that have examined the association of crystal clear urine with the absence of a UTI. 7,8 In the first study, the presence of clear urine had a negative predictive value (NPV) for the absence of UTI of 100%.…”