Dipstick urinalysis for the emergency department evaluation of urinary tract infections in infants aged less than 2 years

Background The clinical diagnosis of urinary tract infection (UTI) in infants under the age of 2 years is challenging because of the nonspecific symptoms and signs in this age group. Prompt diagnosis and treatment is critical, and although dipstick testing allows rapid testing, there is some doubt about its use in infants. We sought to show the use of the dipstick test in identifying or excluding UTI in infants under the age of 2 years presenting to the emergency department with a febrile illness. Methods We conducted a retrospective diagnostic cohort study for over a 12-month period in a UK Paediatric Emergency Department, including all febrile children who had a urine dipstick and a quantitative culture as part of their diagnostic workup. The gold standard was the quantitative culture. Results Three hundred and twenty-one samples were eligible for inclusion. The mean age of the children included was 9.3 months. Sixty-three percent were female children. A test positive for nitrite, leucocyte esterase and blood gave a specificity of 97.12% [95% confidence interval (CI): 94.17-98.60] and a positive likelihood ratio of 15.13 (95% CI: 6.99-32.76). A test negative for nitrite, LE, blood and protein had a sensitivity of 97.44% (95% CI: 91.12-99.29) and a negative likelihood ratio of 0.10 (95% CI: 0.02-0.39). Conclusion In febrile infants who were below 2 years of age, dipstick urinalysis shows promising results in identifying or ruling out a UTI. European Journal of Emergency Medicine 18:221-224 (C) 2011 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.