Related Experiment Videos
Screening tests for urinary tract infection in children: A meta-analysis
1Division of Emergency Medicine, A. I. duPont Hospital for Children, Wilmington, Delaware 19899, USA. mgorelic@nemours.org
Objective:
To review systematically and to summarize the existing literature regarding performance of rapid diagnostic tests for urinary tract infection (UTI) in children.
Design:
Systematic review and meta-analysis.
Methods:
Published articles reporting the performance of urine dipstick tests (leukocyte esterase [LE] and/or nitrite), Gram stain, or microscopic analysis of spun or unspun urine in the diagnosis of UTI in children
Primary Results:
A total of 1489 titles were identified by the MEDLINE search; 26 articles met all criteria for inclusion. There was significant heterogeneity among studies for nearly all tests for both TPR and FPR, which was explained only partially by the stringency of the definition of UTI or age of subjects studied. Based on the pooled estimates, the presence of any bacteria on Gram stain on an uncentrifuged urine specimen had the best combination of sensitivity (0.93) and FPR (0.05). Urine dipstick tests performed nearly as well, with a sensitivity of 0.88 for the the presence of either LE or nitrite and an FPR of 0.04 for the presence of both LE and nitrite. Pyuria had lower TPR and higher FPR: for presence of >5 white blood cells/high-power field in a centrifuged urine sample, the TPR was 0.67 and the FPR was 0.21, whereas for >10 white blood cells per mm(3) in uncentrifuged urine, the TPR was 0.77 and the FPR was 0.11.
Conclusions:
Both Gram stain and dipstick analysis for nitrite and LE perform similarly in detecting UTI in children and are superior to microscopic analysis for pyuria.