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A urine analysis method suitable for children's nappies
A Edwards1, J van der Voort, R Newcombe
1Department of General Practice, University of Wales College of Medicine, Llanedeyrn Health Centre, Cardiff, UK.
Insights
A new method of testing children's urine on panty-liners accurately detects urinary tract infections (UTIs). This simple approach can help identify children needing further urine culture in primary care settings.
Area of Science:
- Pediatric Nephrology
- Clinical Diagnostics
- Infectious Diseases
Background:
- Urinary tract infections (UTIs) in infants are often underdiagnosed, potentially leading to severe complications like renal scarring, hypertension, and renal failure.
- Difficulties in diagnosing UTIs in children necessitate simple and reliable preliminary testing methods.
- Early and accurate diagnosis is crucial to prevent long-term sequelae of pediatric UTIs.
Purpose of the Study:
- To evaluate the diagnostic accuracy of a novel, simple method for detecting urinary tract infections (UTIs) in children.
- To assess the reliability of testing urine for nitrite and leucocyte esterase using panty-liners in a primary care context.
- To determine the feasibility of this method for preliminary screening of pediatric urine samples.
Main Methods:
- An in vitro study compared conventional urine dipstick analysis with analysis of urine-soaked panty-liners using two types of test sticks (Boehringer Mannheim Nephur and Bayer Multistix 8SG).
- The study analyzed agreement, bias, sensitivity, specificity, and negative predictive values for each method.
- Two brands of panty-liners were used in conjunction with the urine analysis test sticks.
Main Results:
- Testing urine on panty-liners demonstrated consistent results comparable to conventional dipstick analysis.
- For laboratory-confirmed UTIs, Boehringer sticks showed 94% sensitivity and 98% negative predictive value at 21.8% prevalence.
- At lower prevalences (1-5%) expected in primary care, both Bayer and Boehringer sticks achieved high negative predictive values (98.7%-99.9%), indicating strong reliability for ruling out UTIs.
Conclusions:
- The panty-liner method for urine testing is accurate and comparable to traditional urine analysis.
- This simple technique holds potential for primary care settings to screen unwell children for UTIs.
- It can effectively identify children who require confirmatory urine culture, improving diagnostic efficiency.
Background:
Urinary tract infection in infancy continues to be underdiagnosed, despite its association with renal scarring and thus hypertension, renal failure, and other sequelae. Low ascertainment of urinary tract infections reflects the many difficulties in establishing a diagnosis, some of which could be eliminated by a simple, reliable method for preliminary investigation of children's urine.
Aim:
To assess the accuracy of a new, simple method for testing urine for nitrite and leucocyte esterase, which could be applied to children in primary care.
Methods:
An in vitro study was carried out to compare the results of conventional urine analysis with urine analysis on urine soaked on to panty-liners, and with the laboratory investigation. Two urine analysis stick types were used (Boehringer Mannheim Nephur sticks and Bayer Multistix 8SG) and two brands of panty-liners. Analysis examined evidence of agreement and bias for different methods in addition to sensitivity, specificity, and negative predictive values for urine analysis.
Results:
Pressing urine analysis test sticks on to panty-liners soaked with urine achieved consistent results compared with the results of conventional dipstick urine analysis. At a prevalence of 21.8%, sensitivity and negative predictive values of urine analysis for laboratory confirmed urinary tract infection were 94% and 98%, respectively, for Boehringer sticks, and 76% and 93%, respectively, for Bayer sticks. At prevalences of 5% and 1% (prevalences that could be expected in primary care) Bayer sticks had negative predictive values of 98.7% and 99.7%, respectively, and Boehringer sticks had values of 99.6% and 99.9%, respectively.
Conclusions:
Testing urine on panty-liners is accurate compared with conventional urine analysis. It may be possible to apply this method to testing unwell children presenting in primary care to identify those who require microbiological urine culture to confirm or eliminate a diagnosis of urinary tract infection.
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