title: Rapid tests and urine sampling techniques for the diagnosis of urinary tract infection (UTI) in children under five years: a systematic review.
abstract: BACKGROUND
  Urinary tract infection (UTI) is one of the most common sources of infection in children under five. Prompt diagnosis and treatment is important to reduce the risk of renal scarring. Rapid, cost-effective, methods of UTI diagnosis are required as an alternative to culture.
  
  
  METHODS
  We conducted a systematic review to determine the diagnostic accuracy of rapid tests for detecting UTI in children under five years of age.
  
  
  RESULTS
  The evidence supports the use of dipstick positive for both leukocyte esterase and nitrite (pooled LR+ = 28.2, 95% CI: 17.3, 46.0) or microscopy positive for both pyuria and bacteriuria (pooled LR+ = 37.0, 95% CI: 11.0, 125.9) to rule in UTI. Similarly dipstick negative for both LE and nitrite (Pooled LR- = 0.20, 95% CI: 0.16, 0.26) or microscopy negative for both pyuria and bacteriuria (Pooled LR- = 0.11, 95% CI: 0.05, 0.23) can be used to rule out UTI. A test for glucose showed promise in potty-trained children. However, all studies were over 30 years old. Further evaluation of this test may be useful.
  
  
  CONCLUSIONS
  Dipstick negative for both LE and nitrite or microscopic analysis negative for both pyuria and bacteriuria of a clean voided urine, bag, or nappy/pad specimen may reasonably be used to rule out UTI. These patients can then reasonably be excluded from further investigation, without the need for confirmatory culture. Similarly, combinations of positive tests could be used to rule in UTI, and trigger further investigation.
authors.affiliation: MRC Health Services Research Collaboration, University of Bristol, England, UK. penny.whiting@bristol.ac.uk
authors.forename: Penny
authors.initials: P
authors.lastname: Whiting
authors.forename: Marie
authors.initials: M
authors.lastname: Westwood
authors.forename: Ian
authors.initials: I
authors.lastname: Watt
authors.forename: Julie
authors.initials: J
authors.lastname: Cooper
authors.forename: Jos
authors.initials: J
authors.lastname: Kleijnen
mesh_terms: D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007668:Kidney / Q000473:pathology; D011237:Predictive Value of Tests; D011934:Reagent Strips; D016482:Urinalysis / Q000379:methods*; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000382:microbiology; D014556:Urine / Q000382:microbiology*
chemical_list: D011934:Reagent Strips