RT Journal Article
SR Electronic
T1 Diagnostic test accuracy of dipstick urinalysis for diagnosing urinary tract infection in febrile infants attending the emergency department
JF Archives of Disease in Childhood
JO Arch Dis Child
FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
SP 1095
OP 1099
DO 10.1136/archdischild-2022-324300
VO 107
IS 12
A1 Thomas Waterfield
A1 Steven Foster
A1 Rebecca Platt
A1 Michael J Barrett
A1 Sheena Durnin
A1 Julie-Ann Maney
A1 Damian Roland
A1 Lisa McFetridge
A1 Hannah Mitchell
A1 Etimbuk Umana
A1 Mark D Lyttle
A1 ,
YR 2022
UL http://adc.bmj.com/content/107/12/1095.abstract
AB 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.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.