Related Experiment Video
Updated: May 9, 2026
Low-Cost, Volume-Controlled Dipstick Urinalysis for Home-Testing
Published on: May 8, 2021
Accuracy of Screening Tests for the Diagnosis of Urinary Tract Infections in Young Children
Nader Shaikh1, Elizabeth A Campbell1, Calise Curry2
1Division of General Academic Pediatrics, University of Pittsburgh School of Medicine.
Insights
For febrile infants and toddlers with suspected urinary tract infections (UTIs), pyuria is absent in about 20% of cases. This finding questions the reliance on pyuria for diagnosing UTIs in this age group.
Area of Science:
- Pediatric infectious diseases
- Clinical diagnostics
- Microbiology
Background:
- Urinary tract infections (UTIs) are common in young children.
- Accurate diagnosis of UTIs is crucial for timely treatment.
- Pyuria is often used as a diagnostic marker for UTIs.
Purpose of the Study:
- To compare the diagnostic accuracy of various pyuria tests, including automated methods.
- To evaluate the clinical implications of using pyuria tests for UTI diagnosis in children.
- To assess the sensitivity of different pyuria detection methods against urine culture.
Main Methods:
- Study included 4188 children aged 1-36 months with suspected UTIs.
- Urine culture served as the reference standard for UTI diagnosis.
- Compared sensitivity of leukocyte esterase, manual microscopy (WBC count), automated flow cytometry, and digital imaging for pyuria detection.
Main Results:
- Among febrile children, leukocyte esterase sensitivity was 84% (95% CI, 0.80-0.87).
- Digital imaging sensitivity for pyuria was 75% (95% CI, 0.66-0.83).
- A significant proportion of children with confirmed UTIs lacked pyuria.
Conclusions:
- Pyuria is absent in approximately 20% of febrile children under 36 months with confirmed UTIs.
- Relying solely on pyuria for UTI diagnosis may lead to missed cases in this population.
- Re-evaluation of diagnostic criteria for pediatric UTIs is warranted.
Background:
The objective of this study was to compare the accuracy of available tests for pyuria, including newer automated tests, and to examine the implications of requiring them for the diagnosis of urinary tract infections (UTIs).
Methods:
We included children between 1 and 36 months of age undergoing bladder catheterization for suspected UTIs who presented to 1 of 3 pediatric centers. Using a positive urine culture result as the reference standard, we compared the sensitivity of 5 modalities for assessing pyuria at the cutoffs most often used clinically for detecting children with a positive culture result: leukocyte esterase on a dipstick, white blood cell (WBC) count on manual microscopy with and without using a hemocytometer, automated WBC enumeration using flow cytometry, and automated WBC enumeration using digital imaging with particle recognition.
Results:
A total of 4188 children were included. Among febrile children, the sensitivity of the 2 most widely available modalities, the leukocyte esterase test and WBC enumeration using digital imaging, had sensitivity values of 84% (95% confidence interval, 0.80-0.87) and 75% (95% confidence interval, 0.66-0.83), respectively.
Conclusions:
Our findings suggest that for febrile children <36 months of age undergoing bladder catheterization for suspected UTI, pyuria will be absent in ∼20% of children who are eventually shown to have pure growth of a pathogen on a culture. This raises questions about the appropriateness of requiring pyuria for the diagnosis of UTIs.
Related Concept Videos
01:26Urinary Tract Infection I: Introduction
01:30Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care
01:17Urinary Tract Infection IV: Nursing Management
01:29Urine Studies I: Urinalysis
01:22Imaging Studies V: Intravenous Urography and Retrograde Pyelography
01:26Urine Studies II: Urine Culture and Sensitivity Test