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Accuracy of Urinalysis for UTI in Spina Bifida
Catherine S Forster1, Rachel G Miller2, Asumi Gibeau1
1University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Insights
Urinalysis findings show moderate accuracy for symptomatic urinary tract infections (UTIs) in children with spina bifida. However, individual test results like pyuria or nitrites alone are insufficient for reliable diagnosis in this population.
Area of Science:
- Pediatric Urology
- Infectious Diseases
- Clinical Diagnostics
Background:
- Urinary tract infections (UTIs) are frequently diagnosed in children with spina bifida.
- Overdiagnosis of UTIs is a concern in this vulnerable pediatric population.
- Accurate diagnostic tools are crucial for timely and appropriate treatment.
Purpose of the Study:
- To evaluate the diagnostic accuracy of urinalysis (UA) findings for symptomatic UTIs in children with spina bifida.
- To determine the sensitivity and specificity of specific UA parameters (nitrites, pyuria, leukocyte esterase).
- To assess the diagnostic performance of UA in children with spina bifida, considering clean intermittent catheterization use.
Main Methods:
- Retrospective cross-sectional study involving 974 encounters from 319 children with myelomeningocele.
- Paired urinalysis (UA) and urine culture data were analyzed from January 2016 to December 2021.
- Generalized estimating equations were used to calculate diagnostic test characteristics for symptomatic UTI.
Main Results:
- Pyuria demonstrated the highest sensitivity, while nitrites were the most specific for UTI.
- Nitrites were the least sensitive, and pyuria was the least specific.
- Diagnostic accuracy was lower in children using clean intermittent catheterization compared to others.
Conclusions:
- Individual urinalysis findings offer moderate sensitivity or specificity but lack overall diagnostic accuracy for symptomatic UTIs in children with spina bifida.
- Relying on single UA parameters can lead to misdiagnosis.
- Further research may be needed to improve diagnostic strategies for UTIs in this population.
Objectives:
Urinary tract infections (UTIs) are common, but overdiagnosed, in children with spina bifida. We sought to evaluate the diagnostic test characteristics of urinalysis (UA) findings for symptomatic UTI in children with spina bifida.
Methods:
Retrospective cross-sectional study using data from 2 centers from January 1, 2016, to December 31, 2021. Children with myelomeningocele aged <19 years who had paired UA (and microscopy, when available) and urine culture were included. The primary outcome was symptomatic UTI. We used generalized estimating equations to control for multiple encounters per child and calculated area under the receiver operating characteristics curve, sensitivity, and specificity for positive nitrites, pyuria (≥10 white blood cells/high-powered field), and leukocyte esterase (more than trace) for a symptomatic UTI.
Results:
We included 974 encounters from 319 unique children, of which 120 (12.3%) met our criteria for UTI. Pyuria had the highest sensitivity while nitrites were the most specific. Comparatively, nitrites were the least sensitive and pyuria was the least specific. When the cohort was limited to children with symptoms of a UTI, pyuria remained the most sensitive parameter, whereas nitrites remained the least sensitive. Nitrites continued to be the most specific, whereas pyuria was the least specific. Among all encounters, the overall area under the receiver operating characteristics curve for all components of the UA was lower in children who use clean intermittent catheterizations compared with all others.
Conclusions:
Individual UA findings have moderate sensitivity (leukocyte esterase or pyuria) or specificity (nitrites) but overall poor diagnostic accuracy for symptomatic UTIs in children with spina bifida.
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