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Original research
Diagnostic test accuracy of dipstick urinalysis for diagnosing urinary tract infection in febrile infants attending the emergency department
  1. Thomas Waterfield1,2,
  2. Steven Foster3,
  3. Rebecca Platt4,
  4. Michael J Barrett5,6,
  5. Sheena Durnin7,8,
  6. Julie-Ann Maney2,
  7. Damian Roland9,10,
  8. Lisa McFetridge11,
  9. Hannah Mitchell11,
  10. Etimbuk Umana1,
  11. Mark D Lyttle12,13
  12. On behalf of Paediatric Emergency Research in the UK and Ireland (PERUKI)
  1. 1Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
  2. 2Emergency Department, Royal Belfast Hospital for Sick Children, Belfast, UK
  3. 3Emergency Department, Royal Hospital for Children, Glasgow, UK
  4. 4Emergency Department, Barts Health NHS Trust, London, UK
  5. 5Emergency Medicine, Children's Health Ireland, Dublin, Ireland
  6. 6Women and Child Health, University College Dublin, Dublin, Ireland
  7. 7Paediatric Emergency Department, Children’s Health Ireland at Crumlin, Dublin, Ireland
  8. 8Discipline of Paediatrics, Trinity College Dublin, Dublin, Ireland
  9. 9Health Sciences, University of Leicester, Leicester, UK
  10. 10Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, University Hospitals of Leicester NHS Trust, Leicester, UK
  11. 11Mathematical Sciences Research Centre, Queen's University Belfast, Belfast, UK
  12. 12Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
  13. 13Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
  1. Correspondence to Dr Thomas Waterfield, Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK; thomas.waterfield{at}googlemail.com

Abstract

Objective To report the diagnostic test accuracy of dipstick urinalysis for the detection of urinary tract infections (UTIs) in febrile infants aged 90 days or less attending the emergency department (ED).

Design Retrospective cohort study.

Patients Febrile infants aged 90 days or less attending between 31 August 2018 and 1 September 2019.

Main outcome measures The sensitivity, specificity and predictive values of dipstick urinalysis in detecting UTIs defined as growth of ≥100 000 cfu/mL of a single organism and the presence of pyuria (>5 white blood cells per high-power field).

Setting Eight paediatric EDs in the UK/Ireland.

Results A total of 275 were included in the final analysis. There were 252 (92%) clean-catch urine samples and 23 (8%) were transurethral bladder catheter samples. The median age was 51 days (IQR 35–68.5, range 1–90), and there were 151/275 male participants (54.9%). In total, 38 (13.8%) participants had a confirmed UTI. The most sensitive individual dipstick test for UTI was the presence of leucocytes. Including ‘trace’ as positive resulted in a sensitivity of 0.87 (95% CI 0.69 to 0.94) and a specificity of 0.73 (95% CI 0.67 to 0.79). The most specific individual dipstick test for UTI was the presence of nitrites. Including trace as positive resulted in a specificity of 0.91 (95% CI 0.86 to 0.94) and a sensitivity of 0.42 (95% CI 0.26 to 0.59).

Conclusion Point-of-care urinalysis is moderately sensitive and highly specific for diagnosing UTI in febrile infants. The optimum cut-point to for excluding UTI was leucocytes (1+), and the optimum cut-point for confirming UTI was nitrites (trace).

Trial registration number NCT04196192.

  • Emergency Care
  • Infectious Disease Medicine
  • Paediatric Emergency Medicine
  • Paediatrics
  • Sepsis

Data availability statement

Data are available in a public, open access repository. All data collected during this study will be available (including data dictionaries) on the Queen’s University Belfast database within 3 months of completion of the study.

https://doi.org/10.1136/archdischild-2022-324300

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    Data availability statement

    Data are available in a public, open access repository. All data collected during this study will be available (including data dictionaries) on the Queen’s University Belfast database within 3 months of completion of the study.

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    Footnotes

    • Twitter @julieannmaney, @damian_roland, @timburgD

    • Collaborators On behalf of Paediatric Emergency Research in the UK and Ireland

    • Contributors TW, MDL, DR and J-AM contributed to the design of the study. TW co-ordinated the running of the study including data management and site training. MDL and TW designed the electronic CRFs. MDL, J-AM, DR, RB, SD and MB and SF were site leads. LM and HM provided statistical expertise and performed the statistical analysis. EM, TW and MDL drafted the manuscript. All authors contributed to the data collection and the writing of the manuscript. TW is guarantor of the study.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.