Utility of simple dipstick test in diagnosing urinary tract infection in children presenting with fever: A prospective observational study

Abstract

Background: Urinary tract infection (UTI) in children continues to be under-diagnosed, despite its association with renal scarring, hypertension, renal failure, and other sequelae. To avoid these preventable complications, we should treat UTIs in children at the earliest. A simple, reliable, bedside test could solve this problem.

Methods: The study was conducted in a tertiary care hospital as a prospective observational study. The study included 534 children until 12 years of age (excluding neonates), presented with fever without focus or fever with urinary complaints. The Rapid diagnostic urine test was performed with a urine dipstick (Combur 10 test®), for urine nitrite, leukocyte esterase, and protein determination. Simultaneously urine culture was also sent. Sensitivity, Specificity, Positive Predictive Value, Negative Predictive Value, and diagnostic accuracy were calculated. Observations: Urine culture was found positive in 80 cases (14.9 %). When all the three tests were positive, diagnostic accuracy was maximum (90.7%). The diagnostic accuracy of the nitrite test was also > 90%. Furthermore, all three tests have very high negative predictive values (> 87%). Conclusion: If all three tests are positive or only nitrite is positive antibiotic should be started and given a full course of treatment irrespective of the urine culture report. All three tests have very high negative predictive values, which excludes UTI. The rapid diagnostic dipstick will reduce the workload of the laboratory. This may guide the clinician in managing OPD as well as inpatient empirical therapy, as delay or untreated UTI can have long-term future implications.