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Related Experiment Videos

Screening dipstick urinalysis: a time to change

R E Kaplan1, J E Springate, L G Feld

  • 1Department of Pediatrics, SUNY at Buffalo School of Medicine, and Biomedical Sciences and Children's Hospital, Buffalo, New York, USA.

Pediatrics
|December 31, 1997
PubMed
Summary

Screening asymptomatic children with multiple dipstick urinalyses is expensive. A single urinalysis at school entry is proposed as a more cost-effective approach for pediatric kidney health.

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Area of Science:

  • Pediatric Nephrology
  • Clinical Cost-Effectiveness Analysis
  • Diagnostic Screening

Background:

  • Dipstick urinalysis is a common screening tool in pediatric primary care.
  • Current guidelines often recommend multiple screenings for asymptomatic children.
  • The cost-effectiveness of these repeated screenings is not well-established.

Purpose of the Study:

  • To determine the minimal cost of screening dipstick urinalyses in a hypothetical cohort of 2000 asymptomatic pediatric patients.
  • To evaluate the cost implications of repeated urinalysis screenings versus a single screening.

Main Methods:

  • A hypothetical cohort of 2000 asymptomatic pediatric patients was modeled.
  • Costs were calculated based on private practitioner charges for in-office tests, commercial laboratory fees, and specialist consultations.

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  • Data from published studies were incorporated into the cost analysis.

    • Main Results:

    • An initial abnormal urinalysis was predicted in 9% of patients, with persistent abnormalities in only 1.5%.
    • The majority of initial abnormalities (84%) were transient or false positives.
    • The minimal cost for four recommended screenings ranged from $20,088 to $25,900, significantly higher than a single screening ($1,290).

    Conclusions:

    • Multiple screening dipstick urinalyses in asymptomatic pediatric patients are excessively costly.
    • Discontinuation of multiple screenings is recommended.
    • A single dipstick urinalysis at school entry (ages 5-6) using a first morning void sample is proposed as a more efficient alternative.