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Report by Bruce Martin, Specialist Registrar in Emergency MedicineChecked by Angaj Ghosh, Senior Clinical Fellow
Clinical scenario
A very anxious mother brings her 4 year old daughter to the emergency department concerned about her persistent fever. Examination reveals that she does indeed have a temperature of 37.6°C. She has no obvious signs of localised infection, so you decide that you need to test her urine to see whether she has got a urinary tract infection (UTI). After much coaxing she provides you with a sample but you now wonder if dipstick analysis is sufficient for diagnosis, or whether you ought to arrange for urgent microscopy.
Three part question
In [children with pyrexia with suspected UTI] is [dipstick urine analysis as sensitive as microscopy] in [ruling out infection]?
Search strategy
Medline 1966–08/01 using the OVID interface. {(exp adolescence/ OR exp child/ or exp child of impaired parents/ or exp child, abandoned/ or exp child, exceptional/ or exp child, hospitalized/ or exp child, institutionalized/ or exp child, preschool/ or exp child, unwanted/ or exp disabled children/ or exp homeless youth/ or exp infant/ or exp only child/ OR child$.mp) OR (exp pediatrics/ OR pediatric$.mp OR paediatric$.mp)} AND (exp Indicators/ and reagents/ OR exp Reagent strips/ OR exp Urinalysis/ OR dipstick.mp) AND (exp Urinary tract infections/ OR urinary tract infection.mp) AND (exp “sensitivity and specificity”/ or “sensitivity and specificity”.mp OR diagnos$.mp OR exp Diagnosis/) LIMIT to human AND english.
Search outcome
Altogether 156 papers found. Of these, one was a recent meta-analysis that included all those papers identified as answering the three part question (table 1)
Clinical bottom line
Children who present with fever and who have positive dipstick testing for leucocyte esterase and nitrite should be given antibiotics and referred for further investigation. Dipstick testing would appear to have the sensitivity for children with negative testing to be discharged, with the urine being sent for Gram stain and culture the following day rather than arranging urgent microscopy.
Report by Bruce Martin, Specialist Registrar in Emergency MedicineChecked by Angaj Ghosh, Senior Clinical Fellow