And so it is with great lament and crocodile tears that we have reached the end of my series on the top ten articles presented at the recent AAP NCE in San Diego. It took me a bit of time to get there, but I think that the journey was worth it. Look for a compilation post in the near future.
Automated Urinalysis and Urine Dipstick in the Emergency Evaluation of Young Febrile Children
Kanegaye JT, Jacob JM, Malicki D. Pediatrics, 2014
Links PubMed Pediatrics
The bottom line
Automated urinalysis is probably as good as dipstick testing for the diagnosis of urinary tract infections
What they did
The authors recruited a convenience sample of 342 children <48 months who had urethral catheterization performed. Automated urinalysis (like what is done for CBC) and traditional dipstick testing were performed and receiver operating characteristic (ROC) analyses were performed and diagnostic indices were calculated for dipstick and automated cell counts at different cutpoints.
- 12% had bacteria ≥50 000/mL on culture
- 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
- POC nitrite 0.76
- Automated leukocyte counts ≥100/μL was 86% sensitive and 98% specific
- Automated bacterial counts ≥250/μL was 98% sensitive and 98% specific
- A urine dipstick with ≥1+ leukocyte esterase or positive nitrite was 95% sensitive and 98% specific
What you can do
- Know that automated urinalysis can be faster that dipstick and may be coming to an ED near you
- Existing data supports the use of automated urinalysis, but its not for everybody, especially given the cost
