title: Automated urinalysis and urine dipstick in the emergency evaluation of young febrile children.
abstract: OBJECTIVE
  The performance of automated flow cytometric urinalysis is not well described in pediatric urinary tract infection. We sought to determine the diagnostic performance of automated cell counts and emergency department point-of-care (POC) dipstick urinalyses in the evaluation of young febrile children.
  
  
  METHODS
  We prospectively identified a convenience sample of febrile pediatric emergency department patients <48 months of age who underwent urethral catheterization to obtain POC and automated urinalyses and urine culture. Receiver operating characteristic analyses were performed and diagnostic indices were calculated for POC dipstick and automated cell counts at different cutpoints.
  
  
  RESULTS
  Of 342 eligible children, 42 (12%) had urinary bacterial growth ≥ 50000/mL. The areas under the receiver operating characteristic curves were: automated white blood cell count, 0.97; automated bacterial count, 0.998; POC leukocyte esterase, 0.94; and POC nitrite, 0.76. Sensitivities and specificities were 86% and 98% for automated leukocyte counts ≥ 100/μL and 98% and 98% for bacterial counts ≥ 250/μL. POC urine dipstick with ≥ 1+ leukocyte esterase or positive nitrite had a sensitivity of 95% and a specificity of 98%. Combinations of white blood cell and bacterial counts did not outperform bacterial counts alone.
  
  
  CONCLUSIONS
  Automated leukocyte and bacterial counts performed well in the diagnosis of urinary tract infection in these febrile pediatric patients, but POC dipstick may be an acceptable alternative in clinical settings that require rapid decision-making.
authors.affiliation: Departments of Pediatrics and Rady Children's Hospital San Diego, San Diego, California jkanegaye@rchsd.org.
authors.forename: John T
authors.initials: JT
authors.lastname: Kanegaye
authors.affiliation: Departments of Pediatrics and Rady Children's Hospital San Diego, San Diego, California.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Jacob
authors.affiliation: Departments of Pediatrics and Rady Children's Hospital San Diego, San Diego, California Pathology, University of California San Diego School of Medicine, La Jolla, California; and.
authors.forename: Denise
authors.initials: D
authors.lastname: Malicki
mesh_terms: D000293:Adolescent; D057205:Automation, Laboratory / Q000379:methods / Q000592:standards; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000379:methods / Q000592:standards*; D004636:Emergency Service, Hospital / Q000592:standards; D005260:Female; D005334:Fever / Q000175:diagnosis* / Q000453:epidemiology / Q000652:urine*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011934:Reagent Strips / Q000592:standards; D013997:Time Factors; D016482:Urinalysis / Q000379:methods / Q000592:standards*; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000652:urine*
chemical_list: D011934:Reagent Strips
keywords: diagnosis; fever; flow cytometry; urinalysis; urinary tract infections