Diagnostic test accuracy of dipstick urinalysis for diagnosing urinary tract infection in febrile infants attending the emergency department
Thomas Waterfield, Steven Foster, Rebecca Platt, Michael J Barrett, Sheena Durnin, Julie-Ann Maney, Damian Roland, Lisa McFetridge, Hannah Mitchell, Etimbuk Umana, Mark D Lyttle, Paediatric Emergency Research in the UK and Ireland (PERUKI), Thomas Waterfield, Steven Foster, Rebecca Platt, Michael J Barrett, Sheena Durnin, Julie-Ann Maney, Damian Roland, Lisa McFetridge, Hannah Mitchell, Etimbuk Umana, Mark D Lyttle, Paediatric Emergency Research in the UK and Ireland (PERUKI)
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.
Keywords: Emergency Care; Infectious Disease Medicine; Paediatric Emergency Medicine; Paediatrics; Sepsis.
Conflict of interest statement
Competing interests: None declared.
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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References
- Kuppermann N, Dayan PS, Levine DA, et al. . A clinical prediction rule to identify febrile infants 60 days and younger at low risk for serious bacterial infections. JAMA Pediatr 2019;173:342–51. 10.1001/jamapediatrics.2018.5501
- Gomez B, Mintegi S, Bressan S, et al. . Validation of the "Step-by-Step" Approach in the Management of Young Febrile Infants. Pediatrics 2016;138. doi:10.1542/peds.2015-4381. [Epub ahead of print: 05 07 2016].
- Waterfield T, Lyttle MD, Munday C, et al. . Validating clinical practice guidelines for the management of febrile infants in the United Kingdom and ireland. Arch Dis Child 2021:1–20.
- Milcent K, Faesch S, Gras-Le Guen C, et al. . Use of procalcitonin assays to predict serious bacterial infection in young febrile infants. JAMA Pediatr 2016;170:62–9. Erratum in: JAMA Pediatr. 2016 Jun 1;170(6):624. 10.1001/jamapediatrics.2015.3210
- Montini G, Toffolo A, Zucchetta P, et al. . Antibiotic treatment for pyelonephritis in children: multicentre randomised controlled non-inferiority trial. BMJ 2007;335:386–8. 10.1136/bmj.39244.692442.55
- Bocquet N, Sergent Alaoui A, Jais J-P, et al. . Randomized trial of oral versus sequential IV/oral antibiotic for acute pyelonephritis in children. Pediatrics 2012;129:e269–75. 10.1542/peds.2011-0814
- Hoberman A, Wald ER, Hickey RW, et al. . Oral versus initial intravenous therapy for urinary tract infections in young febrile children. Pediatrics 1999;104:79–86. 10.1542/peds.104.1.79
- Clinical guideline [CG54]] . Urinary tract infection in under 16S: diagnosis and management, 2018. Available:
- Pantell RH, Roberts KB, Adams WG, et al. . Evaluation and management of Well-Appearing febrile infants 8 to 60 days old. Pediatrics 2021;148:e2021052228. 10.1542/peds.2021-052228
- Buettcher M, Trueck J, Niederer-Loher A, et al. . Swiss consensus recommendations on urinary tract infections in children. Eur J Pediatr 2021;180:663–74. 10.1007/s00431-020-03714-4
- Glissmeyer EW, Korgenski EK, Wilkes J, et al. . Dipstick screening for urinary tract infection in febrile infants. Pediatrics 2014;133:e1121–7. 10.1542/peds.2013-3291
- Velasco R, Benito H, Mozun R, et al. . Group for the study of febrile infant of the RiSEUP-SPERG network. using a urine dipstick to identify a positive urine culture in young febrile infants is as effective as in older patients. Acta Paediatr 2015;104:e39–44.
- Tzimenatos L, Mahajan P, Dayan PS, et al. . Pediatric emergency care applied research network (PECARN). accuracy of the urinalysis for urinary tract infections in febrile infants 60 days and younger. Pediatrics 2018;141:e20173068.
- Lyttle MD, O'Sullivan R, Hartshorn S, et al. . Pediatric emergency research in the UK and ireland (PERUKI): developing a collaborative for multicentre research. Arch Dis Child 2014;99:602–3. 10.1136/archdischild-2013-304998
- Bossuyt PM, Reitsma JB, Bruns DE, et al. . Stard group. STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies. BMJ 2015 Oct;28:h5527.
- Harris PA, Taylor R, Minor BL, et al. . The REDCap Consortium: building an international community of software platform partners. J Biomed Inform 2019;95:103208. 10.1016/j.jbi.2019.103208
- Health research authority decision tool. Available: [Accessed 14 Apr 2022].
Source: PubMed