Influence of gender on the performance of urine dipstick and automated urinalysis in the diagnosis of urinary tract infections at the emergency department

Middelkoop, Stephanie; Pelt, L. Joost van; Kampinga, Greetje A.; Maaten, J. C. ter; Stegeman, Coen A.

doi:10.1016/j.ejim.2021.03.010

Cited by 11 publications

(8 citation statements)

References 23 publications

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“…This could explain the comparatively low specificity and NPV of 54.5 and 42.9 % in participants below 18 years. Dipstick screening was more sensitive in female patients (66.0%) but more specific in males (82.2%), and similar results have been noted in previous studies [12,23].…”

Section: Discussionsupporting

confidence: 89%

Evaluation of the diagnostic performance of the urine dipstick test for the detection of urinary tract infections in patients treated in Kenyan hospitals

Maina

Mwaniki

Mwiti

et al. 2023

Access Microbiology

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Introduction. Culture is the gold-standard diagnosis for urinary tract infections (UTIs). However, most hospitals in low-resource countries lack adequately equipped laboratories and relevant expertise to perform culture and, therefore, rely heavily on dipstick tests for UTI diagnosis. Research gap. In many Kenyan hospitals, routine evaluations are rarely done to assess the accuracy of popular screening tests such as the dipstick test. As such, there is a substantial risk of misdiagnosis emanating from inaccuracy in proxy screening tests. This may result in misuse, under-use or over-use of antimicrobials. Aim. The present study aimed to assess the accuracy of the urine dipstick test as a proxy for the diagnosis of UTIs in selected Kenyan hospitals. Methods. A hospital-based cross-sectional method was used. The utility of dipstick in the diagnosis of UTIs was assessed using midstream urine against culture as the gold standard. Results. The dipstick test predicted 1416 positive UTIs, but only 1027 were confirmed positive by culture, translating to a prevalence of 54.1 %. The sensitivity of the dipstick test was better when leucocytes and nitrite tests were combined (63.1 %) than when the two tests were separate (62.6 and 50.7 %, respectively). Similarly, the two tests combined had a better positive predictive value (87.0 %) than either test alone. The nitrite test had the best specificity (89.8 %) and negative predictive value (97.4 %) than leucocytes esterase (L.E) or both tests combined. In addition, sensitivity in samples from inpatients (69.2 %) was higher than from outpatients (62.7 %). Furthermore, the dipstick test had a better sensitivity and positive predictive value among female (66.0 and 88.6 %) than male patients (44.3 and 73.9 %). Among the various patient age groups, the dipstick test’s sensitivity and positive predictive value were exceptionally high in patients ≥75 years old (87.5 and 93.3 %). Conclusion. Discrepancies in prevalence from the urine dipstick test and culture, the gold standard, indicate dipstick test inadequacy for accurate UTI diagnosis. The finding also demonstrates the need for urine culture for accurate UTI diagnosis. However, considering it is not always possible to perform a culture, especially in low-resource settings, future studies are needed to combine specific UTI symptoms and dipstick results to assess possible increases in the test’s sensitivity. There is also a need to develop readily available and affordable algorithms that can detect UTIs where culture is not available.

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Section: Discussionsupporting

confidence: 89%

Evaluation of the diagnostic performance of the urine dipstick test for the detection of urinary tract infections in patients treated in Kenyan hospitals

Maina

Mwaniki

Mwiti

et al. 2023

Access Microbiology

View full text Add to dashboard Cite

show abstract

“…First, we observe a performance gap between the female and male subgroups when investigating the model’s performance across patient subgroups. This gap has been identified by other clinical studies for urine dipstick tests, where the diagnostic accuracy of urine dipstick has been found to be higher in males than in females [ 52 ]. On the other hand, another study observes a higher performance of an XGboost model in the prediction of suspected urinary tract infections in the emergency department within the female subgroup [ 53 ].…”

Section: Discussionmentioning

confidence: 93%

“…On the other hand, another study observes a higher performance of an XGboost model in the prediction of suspected urinary tract infections in the emergency department within the female subgroup [ 53 ]. This suggests that future work can focus on the development of fairer models across females and males [ 52 ].…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a parsimonious prediction model for positive urine cultures in outpatient visits

Ghosheh,

St John,

Wang

et al. 2023

PLOS Digit Health

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Urine culture is often considered the gold standard for detecting the presence of bacteria in the urine. Since culture is expensive and often requires 24-48 hours, clinicians often rely on urine dipstick test, which is considerably cheaper than culture and provides instant results. Despite its ease of use, urine dipstick test may lack sensitivity and specificity. In this paper, we use a real-world dataset consisting of 17,572 outpatient encounters who underwent urine cultures, collected between 2015 and 2021 at a large multi-specialty hospital in Abu Dhabi, United Arab Emirates. We develop and evaluate a simple parsimonious prediction model for positive urine cultures based on a minimal input set of ten features selected from the patient’s presenting vital signs, history, and dipstick results. In a test set of 5,339 encounters, the parsimonious model achieves an area under the receiver operating characteristic curve (AUROC) of 0.828 (95% CI: 0.810-0.844) for predicting a bacterial count ≥ 105 CFU/ml, outperforming a model that uses dipstick features only that achieves an AUROC of 0.786 (95% CI: 0.769-0.806). Our proposed model can be easily deployed at point-of-care, highlighting its value in improving the efficiency of clinical workflows, especially in low-resource settings.

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“…Despite this, women receive less evidence-based medicine than men for the management of their urinary system [142]. For diagnosis, urine dipsticks give more false positives in women (8.7%) than in men (5.6%) [143]. The performance of automated urinalysis is better for men than for women [143].…”

Section: The Urinary System: a Well-known Differencementioning

confidence: 99%

“…For diagnosis, urine dipsticks give more false positives in women (8.7%) than in men (5.6%) [143]. The performance of automated urinalysis is better for men than for women [143].…”

Section: The Urinary System: a Well-known Differencementioning

confidence: 99%

The Appropriateness of Medical Devices Is Strongly Influenced by Sex and Gender

Campesi,

Franconi,

Serra

2024

Life

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Until now, research has been performed mainly in men, with a low recruitment of women; consequentially, biological, physiological, and physio-pathological mechanisms are less understood in women. Obviously, without data obtained on women, it is impossible to apply the results of research appropriately to women. This issue also applies to medical devices (MDs), and numerous problems linked to scarce pre-market research and clinical trials on MDs were evidenced after their introduction to the market. Globally, some MDs are less efficient in women than in men and sometimes MDs are less safe for women than men, although recently there has been a small but significant decrease in the sex and gender gap. As an example, cardiac resynchronization defibrillators seem to produce more beneficial effects in women than in men. It is also important to remember that MDs can impact the health of healthcare providers and this could occur in a sex- and gender-dependent manner. Recently, MDs’ complexity is rising, and to ensure their appropriate use they must have a sex–gender-sensitive approach. Unfortunately, the majority of physicians, healthcare providers, and developers of MDs still believe that the human population is only constituted by men. Therefore, to overcome the gender gap, a real collaboration between the inventors of MDs, health researchers, and health providers should be established to test MDs in female and male tissues, animals, and women.

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Influence of gender on the performance of urine dipstick and automated urinalysis in the diagnosis of urinary tract infections at the emergency department

Cited by 11 publications

References 23 publications

Evaluation of the diagnostic performance of the urine dipstick test for the detection of urinary tract infections in patients treated in Kenyan hospitals

Evaluation of the diagnostic performance of the urine dipstick test for the detection of urinary tract infections in patients treated in Kenyan hospitals

Development and validation of a parsimonious prediction model for positive urine cultures in outpatient visits

The Appropriateness of Medical Devices Is Strongly Influenced by Sex and Gender

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