Diagnostic test accuracy of dipstick urinalysis for diagnosing urinary tract infection in febrile infants attending the emergency department

Waterfield, Thomas; Foster, Steven; Platt, Rebecca; Barrett, Michael J.; Durnin, Sheena; Maney, Julie-Ann; Roland, Damian; McFetridge, Lisa; Mitchell, Hannah; Umana, Etimbuk; Lyttle, Mark D

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.

• Journal Article Type: Article
• Acceptance Date: Aug 8, 2022
• Online Publication Date: Aug 24, 2022
• Publication Date: Dec 1, 2022
• Deposit Date: Sep 23, 2022
• Publicly Available Date: Sep 23, 2022
• Journal: Archives of disease in childhood
• Print ISSN: 0003-9888
• Electronic ISSN: 1468-2044
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 107
• Issue: 12
• Pages: 1095-1099
• DOI: https://doi.org/10.1136/archdischild-2022-324300
• Keywords: Original research, 1506, Emergency Care, Infectious Disease Medicine, Paediatric Emergency Medicine, Paediatrics, Sepsis
• Public URL: https://uwe-repository.worktribe.com/output/9960963
• Publisher URL: https://adc.bmj.com/content/early/2022/09/05/archdischild-2022-324300