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An Examination of the Test Characteristics of the Pediatric Urinaly   Message List  
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Acad Emerg Med Volume 13, Number 5_suppl_1 170-171,
© 2006 Society for Academic Emergency Medicine
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PEDIATRICS

An Examination of the Test Characteristics of the Pediatric Urinalysis

Mark Clark, Kurt Weber and Karen Bakewell
Orlando Regional Medical Center, Orlando, GA
ABSTRACT
Background: Urinary tract infection is an important problem that is frequently encountered by pediatric health care providers. The urinalysis is employed as a surrogate for the urine culture in screening for urinary tract infections (UTIs). However, the reported test characteristics vary widely and, to the best of the authors' knowledge, there exists no published standard for interpreting these findings.
Objective: The objective of this study was to describe the test characteristics of specific urinalysis components for diagnosing UTI.
Methods: The study design was an observational, retrospective chart review. A cohort of 1,216 pediatric patients less than 48 months of age who presented to an urban, pediatric emergency department (ED) and had a urinalysis ordered were evaluated. Urinalyses were coupled with urine culture results, and sensitivity, specificity, and predictive values were calculated.
Results: Overall prevalence of positive cultures was 11.1%. For culture-proven UTIs, the presence of nitrate in the urinalysis showed a sensitivity of 19.3% and a specificity of 99.9%. The presence of any leukocyte esterase (LE) showed a sensitivity of 67.4% and a specificity of 82.5%. The positive predictive value of 1+LE, 2+LE, and 3+LE was 13.5%, 33.9%, and 73.9%, respectively. The specificity of ≥2+LE was 94.9%. Urinalysis considered negative (no LE/nitrate/blood) had a positive culture rate of 4%.
Conclusions: The detection of nitrates in the urinalysis is highly specific for the presence of a urinary tract infection, whereas its absence does not rule out infection. At any cutoff point, LE is a poor screening test for diagnosing infection, but presence of ≥2+LE is nearly as specific as the presence of nitrate.


Sat Sep 23, 2006 11:21 am

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