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Fast and Sensitive: Automated Point-of-Care Urine Dips
Laurie Malia1, Kaitlin Strumph, Sharon Smith
1From the Connecticut Children's Medical Center, Hartford, CT.
Insights
Point-of-care (POC) urine dipstick tests are as sensitive as laboratory urinalysis for detecting urinary tract infections (UTI) in children. This finding supports the use of rapid POC testing in pediatric emergency settings.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Diagnostics
- Infectious Disease
Background:
- Point-of-care (POC) urine dipstick tests are widely used in pediatric emergency departments (PED) due to their speed and low cost.
- Previous research indicates that urine dipsticks and automated urinalysis are sensitive predictors of urinary tract infection (UTI) in children under 48 months.
- The accuracy of POC dip testing compared to laboratory urinalysis for UTI diagnosis in children has been investigated.
Purpose of the Study:
- To evaluate the diagnostic accuracy of point-of-care (POC) urine dipstick testing compared to laboratory urinalysis for identifying urinary tract infections (UTI) in pediatric patients.
- To determine if POC dip testing is as accurate as traditional laboratory urinalysis in the diagnosis of UTI in a pediatric emergency department setting.
Main Methods:
- A retrospective chart review of 334 pediatric patients (birth to 18 years) who presented to a PED between January 2015 and December 2015.
- Inclusion criteria required patients to have undergone POC dip, laboratory urinalysis (lab UA), and urine culture during their visit.
- Urine culture served as the criterion standard, with positive POC dip defined by leukocyte esterase or nitrites, and positive lab UA by leukocyte esterase, nitrites, or >10 WBCs/hpf.
Main Results:
- The sensitivity and specificity of POC dip testing were 91.4% and 63.9%, respectively.
- Laboratory urinalysis demonstrated similar sensitivity (91.4%) and specificity (63.9%).
- Laboratory dipstick analysis showed a sensitivity of 88.6% and specificity of 65.6%.
Conclusions:
- Point-of-care urine dipstick tests exhibit comparable sensitivity to laboratory urinalysis in detecting UTIs in pediatric patients.
- The findings suggest that POC dip testing is a reliable method for UTI screening in the PED.
- Further prospective studies are recommended to explore demographic factors influencing POC dip-diagnosed UTIs.
Objective:
Point-of-care (POC) urine dipstick is a highly used test in the pediatric emergency department (PED) owing to its fast turn-around time and inexpensive cost. Past studies have shown hand-held urine dipsticks and automated urinalysis in children younger than 48 months to be sensitive predictors for urinary tract infection (UTI). It is hypothesized that POC dip testing is as accurate as laboratory urinalysis in the diagnosis of UTI.
Methods:
A retrospective chart review was conducted on patients (aged birth through 18 years) presenting to a PED between January 2015 and December 2015. Eligible subjects included those that had a POC dip, laboratory urinalysis (lab UA), and urine culture performed during their PED visit. Subjects were selected, using a random number generator; 334 charts were selected. A positive POC dip was defined as having a positive leukocyte esterase or the presence of nitrites. A positive lab UA was defined as having a positive leukocyte esterase, nitrites, or greater than 10 white blood cells per high-power field. Urine culture was used as the criterion standard for comparison.
Results:
A total of 334 subjects' charts were reviewed. Sensitivity and specificity of the POC dip were 91.4% (95% confidence interval [CI], 76.9%-98.2%) and 63.9% (95% CI, 57.2%-69.3%); lab UA, 91.4% (95% CI, 76.9%-98.2%) and 63.9% (95% CI, 58.2%-69.3%); and lab dip, 88.6% (95% CI, 73.3%-96.8%) and 65.6% (95% CI, 59.9%-70.9%).
Conclusions:
Point-of-care dips are as sensitive in detecting UTI as the lab UA. A prospective study could allow for further demographic evaluation of POC dip diagnosed UTI.
