title: The validity of the uriscreen test for early detection of urinary tract infection in children.
abstract: OBJECTIVE
  To determine the validity of the Uriscreen, a rapid diagnostic test based on the detection of urine catalase for the early detection of urinary tract infection (UTI) in children, compared with standard urinalysis and dipstick tests. STUDY DESIGN. Cross-sectional study.
  
  
  METHODS
  Children 1 month to 17 years of age who presented to the emergency department of a pediatric tertiary care center between March and November of 1996 with symptoms suggestive of UTI.
  
  
  METHODS
  Urine specimens obtained from a random sample of 121 patients were evaluated simultaneously for possible UTI by Uriscreen (catalase test), urinalysis (microscopic pyuria), dipstick (leukocyte esterase and nitrite), and quantitative urine culture. All specimens were collected by one of three sterile techniques (midstream void technique, bladder catheterization, or suprapubic aspiration), as appropriate for age, and tested immediately. Using the quantitative urine culture as the gold standard (reference test), the sensitivity, specificity, and positive and negative predictive values of all the screening tests were determined and compared. Age, sex, temperature, presenting symptoms, and method of urine collection were recorded for each participant.
  
  
  RESULTS
  Of the 121 patients, 35 (28.9%) had positive culture results: 30 girls (85.7%) and 5 boys (14.3%). Compared with urinalysis and dipstick tests, Uriscreen had the highest sensitivity (100% vs 88.6% and 97.1%, respectively) and the highest negative predictive value (100% vs 95% and 98.6%, respectively), but the poorest specificity (68.6% vs 88.4% and 82.5%, respectively) and positive predictive value (56.4% vs 75.6% and 69.4%, respectively).
  
  
  CONCLUSIONS
  The clinical use of Uriscreen for the presumptive diagnosis of UTI in children is limited and not significantly superior to urinalysis or the dipstick test. However, because of its 100% sensitivity and negative predictive value and its ease of use, rapidity, and low cost, it is recommended highly for ruling out the diagnosis of UTI. In laboratories, a negative Uriscreen result may prevent the need for performing expensive urine cultures.
authors.affiliation: Unit of Emergency Medicine, Schneider Children's Medical Center of Israel, Petah Tiqva, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. waisy@clalit.org.il
authors.forename: Y
authors.initials: Y
authors.lastname: Waisman
authors.forename: E
authors.initials: E
authors.lastname: Zerem
authors.forename: L
authors.initials: L
authors.lastname: Amir
authors.forename: M
authors.initials: M
authors.lastname: Mimouni
mesh_terms: D001437:Bacteriuria / Q000175:diagnosis; D002374:Catalase / Q000032:analysis*; D015169:Colony Count, Microbial; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011237:Predictive Value of Tests; D011776:Pyuria / Q000175:diagnosis; D011897:Random Allocation; D011934:Reagent Strips; D012680:Sensitivity and Specificity; D016482:Urinalysis; D014552:Urinary Tract Infections / Q000175:diagnosis*; D014556:Urine / Q000737:chemistry / Q000382:microbiology
chemical_list: D011934:Reagent Strips; D002374:Catalase