Reliability of a urine dipstick in emergency department patients

Propp, Douglas A.; Weber, Deborah; Ciesla, Mary Lou

doi:10.1016/s0196-0644(89)80844-3

Cited by 21 publications

(10 citation statements)

References 14 publications

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“…This conclusion is supported in diVerent settings by other published reports with respect to leucocyte esterase, 1 nitrate, 2 and leucocyte esterase and nitrite tests. 3 Two groups, however, have reported that dipstick tests are a good screening method for urinary tract infections in new paediatric patients. 4 5 With a false positive result rate of 40%, semiquantitative microscopic estimation of bacteria (per HPF or per µl) is also an unreliable marker of infected urine.…”

Section: Discussionmentioning

confidence: 99%

Disappointing dipstick screening for urinary tract infection in hospital inpatients.

Zaman¹,

Borremans²,

Verhaegen³

et al. 1998

J Clin Pathol

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Aim-To compare the performance of leucocyte esterase and nitrite dipstick tests with microscopic examination and culture of first morning urines (n = 420) of hospital inpatients. Results-The sensitivity, specificity, and negative predictive value of the leucocyte esterase test for the cutoV of > 10 WBC/µl were 57%, 94%, and 68%, respectively. For > 5 WBC per high power field (HPF) these variables were 84%, 90%, and 93%. For > 10 5 colony counts/ml, the sensitivity of the nitrite test was 27%, specificity 94%, and negative predictive value 87%. When either leucocyte esterase or nitrite positivity was accepted as a marker of urinary tract infection, the sensitivity was 78%, specificity 75%, and negative predictive value 94%, and there were 22% false negative results. Semiquantitative microscopic estimation of bacteria per HPF yielded 40% false positives. Conclusions-Leucocyte esterase and nitrite dipstick tests are not suitable for screening for urinary tract infections. (J Clin Pathol 1998;51:471-472) Keywords: leucocyte esterase; nitrite; dipstick Screening of urine specimens for urinary tract infection by means of dipstick leucocyte esterase and nitrite test is not an uncommon practice, although the standard method for diagnosis of infected urine remains microscopic examination and quantitative culture of urine. We have evaluated the diagnostic performance of the dipstick test in hospital inpatients in comparison with the microscopic and culture results. MethodsOver a three week period, 420 first morning urine samples from hospital inpatients on which urine cultures had been requested were randomly selected for additional tests. These tests included (1) test strip screening with multistix 8 SG (Bayer Corporation, New York, USA), (2) direct microscopic counting of the white blood cells (WBC) and bacteria per microlitre of urine using Kova counting chambers (Hycor Biomedical Inc, California, USA), (3) urine sediment microscopy, after centrifugation at 350 g for five minutes, to obtain WBC and bacteria per high power field (HPF). The strips were read by reflectance spectrophotometric method on Clinitek 200+ (Bayer).Urine cultures were performed by inoculating, from a standard loop, 10 µl of uncentrifuged and well mixed urines on to blood agar and MacConkey plates (Oxoid, Hampshire, UK) and incubating aerobically at 37°C overnight. Growth of < 10 000 colony forming units (CFU) per ml was considered negative.The patients consisted of 234 females (mean age 55 years, range 17 days to 97 years) and 186 males (mean age 58 years, range 9 to 94 years) and they belonged to the following general groups: paediatrics (4), oncology (5), obstetrics/gynaecology (39), surgery (51), geriatrics (57), ambulant consultation (68), internal medicine (93) and medical and postoperative intensive care (103). ResultsUsing the standard criterion of > 10 5 CFU/ml for urinary tract infection, 72 patients' urines (17%) produced positive cultures. Of these 18 (25%) were infected with non-nitrate-reducing organism, these being mainly ...

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Section: Discussionmentioning

confidence: 99%

Disappointing dipstick screening for urinary tract infection in hospital inpatients.

Zaman¹,

Borremans²,

Verhaegen³

et al. 1998

J Clin Pathol

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“…We were unable to find other studies evaluating early urine collection and the impact on ED LOS. Some literature exists regarding point-of-care testing with urine dipstick as a means to improve the efficiency of urinalysis testing but poor sensitivities and specificities to diagnose urinary tract infection by dipstick in several studies may limit the benefit of this type of testing [30]. Further, this intervention addresses time of testing but not the time to acquire the sample from the patient, the interval of interest in this study.…”

Section: Discussionmentioning

confidence: 99%

Impact of Early Urine Specimen Collection on Emergency Department Time to Disposition: A Randomized Controlled Trial

Bahl

Jamali²,

Ramesh

2020

Cureus

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“…Combining nitrite parameter with leukocyte esterase, the sensitivity for prediction of UTI increased (~ 63%) but the specificity fell (~83%) in our study. [16][17][18][19] The negative predictive value for UTI using the two parameters was high (90.6%). Thus the two tests together increased overall accuracy for prediction of UTI.…”

Section: Discussionmentioning

confidence: 99%

Urinary Dipsticks: Efficacy as Predictor of Urinary Tract Infections

Bagga¹

2016

JBMOA

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Urinalysis and culture are the two most common investigations performed in a microbiology laboratory. Commercial Dipsticks which detect proteins and various enzymes may offer a rapid and inexpensive alternative to urinalysis and culture. An evaluation of the utility of urinary dipsticks (Multistix 10 SG) in predicting urinary tract infections (UTI) was undertaken. A total of 667 urine samples were evaluated from May to August 2012. Sensitivity, specificity, negative and positive predictive values were evaluated. The sensitivity for predicting UTI was low: 62% for leukocyte esterase and nitrite; 67% for leukocyte esterase and proteinuria while it was 74% for leukocyte esterase, nitrite and proteinuria, all three together. However, the negative predictive value (NPV) for UTI was better. NPV for UTI with leukocyte esterase and nitrite was 90.3%; for leukocyte esterase and proteinuria was 90.6% while it was 91.5 % for leukocyte esterase, nitrite and proteinuria together. The positive predictive value was very low. Urinary dipsticks therefore appear to be better tools for excluding UTIs and not for diagnosing UTI.

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Reliability of a urine dipstick in emergency department patients

Cited by 21 publications

References 14 publications

Disappointing dipstick screening for urinary tract infection in hospital inpatients.

Disappointing dipstick screening for urinary tract infection in hospital inpatients.

Impact of Early Urine Specimen Collection on Emergency Department Time to Disposition: A Randomized Controlled Trial

Urinary Dipsticks: Efficacy as Predictor of Urinary Tract Infections

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