Do all Pediatric Urine Specimens Need to Go to the Laboratory?

Authors

  • Syed Rehan Ali Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
  • Shakeel Ahmed Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
  • Sobia Nizami Aga Khan University Medical College, Karachi, Pakistan
  • Maqbool Qadir Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan

DOI:

https://doi.org/10.6000/1929-4247.2012.01.01.08

Keywords:

Urinary tract infection, pediatric, dipstick, urinalysis, accuracy

Abstract

Objective: This study aimed to evaluate the accuracy of the urine dipstick in diagnosing UTIs in children at a tertiary care centre in Pakistan.

Methods: 72 inpatients at the Aga Khan Hospital pediatric ward, getting laboratory urinalysis due to UTI suspicion, were included. Dipstick tests were done on the urine samples being sent to the lab for microscopy. The sensitivity, specificity and likelihood ratios (LRs) of dipstick LE, and pyuria and bacteriuria on microscopy were calculated and compared, using urine culture results as the gold standard for diagnosis.

Results: The specificity of dipstick LE, pyuria and bacteriuria were 77%, 77% and 90% respectively, while the positive likelihood ratios were was 28%, 44% and 49% respectively. Urine cultures were done for 58 patients, with 5 positive cultures, so plausible estimates of sensitivity were not made.

Conclusions: Urine microscopy is a more accurate screening test for ruling in UTIs than the dipstick. Keeping in mind its diagnostic limitations, the dipstick can be used to help rule in a UTI, although confirmation by cultures is recommended. Further studies are needed to validate these results in children and to evaluate the dipstick’s sensitivity for ruling out disease.

References

Whiting P, Westwood M, Watt I, Cooper J, Kleijnen J. Rapid tests and urine sampling techniques for the diagnosis of urinary tract infection (UTI) in children under five years: a systematic review. BMC Pediatr 2005; 5(1): 4. http://dx.doi.org/10.1186/1471-2431-5-4

Afzal S, Naemullah S. Spectrum of the Microorganisms in Children with Urinary Tract Infection. J Rawalpindi Med Coll 2008; 12(2): 44-46.

Shaikh N, Morone NE, Lopez J, et al. Does this child have a urinary tract infection? JAMA 2007; 298(24): 2895-904. http://dx.doi.org/10.1001/jama.298.24.2895

St John A, Boyd JC, Lowes AJ, Price CP. The use of urinary dipstick tests to exclude urinary tract infection: a systematic review of the literature. Am J Clin Pathol 2006; 126(3): 428-36. http://dx.doi.org/10.1309/C69RW1BT7E4QAFPV

Shaikh N, Morone NE, Bost JE, Farrell MH. Prevalence of urinary tract infection in childhood: a meta-analysis. Pediatr Infect Dis J. 2008; 27(4): 302-8. http://dx.doi.org/10.1097/INF.0b013e31815e4122

Rehmani R. Accuracy of Urine Dipstick to predict Urinary Tract infections in an Emergency Department. J Ayub Med Coll Abottabad 2004; 16(1): 4-7.

Williams GJ, Macaskill P, Chan SF, Turner RM, Hodson E, Craig JC. Absolute and relative accuracy of rapid urine tests for urinary tract infection in children: a meta-analysis. Lancet Infect Dis 2010; 10(4): 240-50. http://dx.doi.org/10.1016/S1473-3099(10)70031-1

Devillé WL, Yzermans JC, van Duijn NP, Bezemer PD, van der Windt DA, Bouter LM. The urine dipstick test useful to rule out infections: A meta-analysis of the accuracy. BMC Urol 2004; 2(4): 4.

Mori R, Yonemoto N, Fitzgerald A, Tullus K, Verrier-Jones K, Lakhanpaul M. Diagnostic performance of urine dipstick testing in children with suspected UTI: a systematic review of relationship with age and comparison with microscopy. Acta Paediatr 2010; 99(4): 581-4. http://dx.doi.org/10.1111/j.1651-2227.2009.01644.x

Attia J. Moving beyond sensitivity and specificity: using likelihood ratios to help interpret diagnostic tests. Aust Prescr 2003; 26: 111-13.

Patel HP. The abnormal urinalysis. Pediatr Clin North Am 2006; 53(3): 325-37. http://dx.doi.org/10.1016/j.pcl.2006.02.004

Downloads

Published

2012-09-26

How to Cite

Ali, S. R., Ahmed, S., Nizami, S., & Qadir, M. (2012). Do all Pediatric Urine Specimens Need to Go to the Laboratory?. International Journal of Child Health and Nutrition, 1(1), 66–71. https://doi.org/10.6000/1929-4247.2012.01.01.08

Issue

Section

General Articles