The case against screening urinalyses for asymptomatic bacteriuria in children

Area of Science:

• Pediatric Nephrology
• Diagnostic Test Evaluation
• Public Health Policy

Background:

• Asymptomatic bacteriuria screening is recommended for children to prevent pyelonephritis and renal scarring.
• The cost-effectiveness of this screening practice remains unestablished.

Purpose of the Study:

• To evaluate the costs and benefits of screening asymptomatic, toilet-trained children for bacteriuria.
• To determine if current screening methods are effective in preventing adverse renal outcomes.

Main Methods:

• Systematic review of published studies on screening for asymptomatic bacteriuria in children.
• Analysis of screening test sensitivity and specificity, bacteriuria prevalence, and associated costs.
• Evaluation of evidence linking bacteriuria detection to prevention of pyelonephritis and renal scarring.

Main Results:

• Screening 100,000 children yields nearly 20,000 false-positive results with current methods (80% sensitivity/specificity).
• The diagnostic process misses 28% of true bacteriuria cases and costs approximately $2.9 million.
• No evidence supports that detecting and treating asymptomatic bacteriuria prevents pyelonephritis or renal scarring.

Conclusions:

• Screening for asymptomatic bacteriuria in children is expensive and ineffective.
• Current screening practices fail to prevent pyelonephritis and renal scarring.
• Routine screening for asymptomatic bacteriuria should be discontinued in pediatric well-child care.