Is a negative dipstick urinalysis good enough to exclude urinary tract infection in paediatric emergency department patients?
BACKGROUND
Urinary tract infection is a common cause of serious bacterial infection in young children. The non-specific presentation has implications for misdiagnosis and the potential for long-term complications.


OBJECTIVE
To determine if a negative dipstick urinalysis is adequate to exclude urinary tract infection in children aged 0-10 years. Data was subdivided into two age groups: 0-2 years and 2-10 years.


METHODS
Retrospective case note review over an 8-month period. Cases included required a printed urinalysis recorded from the Clinitek 50 (Bayer) machine and a printed microscopy and culture result. We defined a negative urinalysis as being negative for all of blood, protein, leucocytes and nitrites. A total of 375 cases were included for statistical calculation.


RESULTS
Three hundred and seventy-five cases gave a prevalence of 10.7% with a sensitivity of 92.5%, specificity of 39.4% and a negative predictive value of 97.8%. In the 0-2-year-old group, we demonstrated a prevalence of 15%, a sensitivity of 87.5%, specificity of 39.7% and a negative predictive value of 94.7%. This compares to the older group (2-10 years) with a prevalence of 7.0%, a sensitivity of 100%, specificity of 39.7% and a negative predictive value of 100%.


CONCLUSIONS
Prevalence of urinary tract infection varied with age with a higher prevalence in the 0-2 years age group. The lower negative predictive value and the higher clinical importance in this age group means that dipstick urinalysis is inadequate to exclude urinary tract infection. Conversely, we believe that children in the 2-10 years age group can adequately have urinary tract infection excluded with a negative dipstick urinalysis.
Doley
Andrew
A
Department of Emergency Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia. andrew.doley@fmc.sa.gov.au
Nelligan
Melissa
M
D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016482:Urinalysis; D014552:Urinary Tract Infections / Q000175:diagnosis*