title: Visual or automated dipstick testing for proteinuria in pregnancy?
abstract: OBJECTIVE
  To compare the Multistix 10SG/visual-read with two automated methods (Multistix 10SG/Clinitek 50 and Chemstrip 10A/Urisys 1100) to detect significant proteinuria among high-risk pregnant women.
  
  
  METHODS
  Prospective cohort study at British Columbia Women's Hospital & Health Centre, Vancouver, Canada.
  
  
  METHODS
  Diagnostic accuracy determined by sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR-).
  
  
  RESULTS
  303 (89.6%) of 338 women had a urine sample tested by all three dipstick methods. 196 samples (64.7%) were collected in the morning (subsequent to their first void) and from outpatients. 107 samples (35.3%) were from inpatients at various times throughout the day. A PrCr ⩾30mg/mmol was present in 46 (15.2%) samples. The sensitivity for proteinuria was higher with Multistix 10SG/Clinitek 50 (65.2%) than with Multistix 10SG/visual-read (41.3%, p<0.001) or Chemstrip 10A/Urisys 1100 (54.3%, p=0.06). Specificity was >90% for all methods studied, although it was highest for Multistix 10SG/visual-read (98.4%) compared with either Multistix 10SG/Clinitek 50 (92.6%, p<0.001) or Chemstrip 10A/Urisys 1100 (95.7%, p=0.04). For all methods, LR+ was good-excellent (>5), but LR- poor-fair (>0.20). 29 samples were discordant for proteinuria between methods. 28/29 women had negative proteinuria by Multistix 10SG/visual-read, but at least 1+ proteinuria by an automated method; 17/28 were false positives and 11/28 true positives.
  
  
  CONCLUSIONS
  Automated dipstick methods are more sensitive than visual urinalysis for proteinuria, but test performance is still only poor-fair as a 'rule-out' test for proteinuria. Whether the enhanced sensitivity would be worth the false positives, cost, and personnel training remains to be determined for detection of low-level proteinuria in pregnancy.
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, 4500 Oak Street, Vancouver, BC V6H 3N1, Canada; Department of Obstetrics and Gynaecology, Universidad Austral de Chile, Simpson 850, Valdivia, Chile.
authors.forename: Mauricio E
authors.initials: ME
authors.lastname: Correa
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, 4500 Oak Street, Vancouver, BC V6H 3N1, Canada; Department of Medicine, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, QC J1H 5N4, Canada.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Côté
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, 4500 Oak Street, Vancouver, BC V6H 3N1, Canada.
authors.forename: Dane A
authors.initials: DA
authors.lastname: De Silva
authors.affiliation: Department of Pathology and Laboratory Medicine, Children's & Women's Health Centre of British Columbia and the University of British Columbia, 4500 Oak Street, Vancouver, BC V6H 3N1, Canada.
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Obstetrics and Gynaecology, University Hospitals Leicester, Gwendolen Road, Leicester LE5 4PW, UK.
authors.forename: Prianthiny
authors.initials: P
authors.lastname: Packianathan
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, 4500 Oak Street, Vancouver, BC V6H 3N1, Canada; Molecular and Clinical Sciences Research Institute, St. George's, University of London, UK; Child and Family Research Institute, University of British Columbia, 950 West 28th Avenue, Vancouver, BC V5Z 4H4, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: von Dadelszen
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, 4500 Oak Street, Vancouver, BC V6H 3N1, Canada; Molecular and Clinical Sciences Research Institute, St. George's, University of London, UK; Child and Family Research Institute, University of British Columbia, 950 West 28th Avenue, Vancouver, BC V5Z 4H4, Canada. Electronic address: LMagee@sgul.ac.uk.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Magee
mesh_terms: D001322:Autoanalysis; D015331:Cohort Studies; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D011225:Pre-Eclampsia / Q000652:urine; D011247:Pregnancy; D011446:Prospective Studies; D011507:Proteinuria / Q000175:diagnosis / Q000652:urine*; D011934:Reagent Strips; D012680:Sensitivity and Specificity
chemical_list: D011934:Reagent Strips
keywords: Dipstick; Preeclampsia; Pregnancy; Proteinuria