From the Connecticut Children's Medical Center, Hartford, CT.
Pediatr Emerg Care. 2020 Oct;36(10):486-488. doi: 10.1097/PEC.0000000000001357.
Point-of-care (POC) urine dipstick is a highly used test in the pediatric emergency department (PED) owing to its fast turn-around time and inexpensive cost. Past studies have shown hand-held urine dipsticks and automated urinalysis in children younger than 48 months to be sensitive predictors for urinary tract infection (UTI). It is hypothesized that POC dip testing is as accurate as laboratory urinalysis in the diagnosis of UTI.
A retrospective chart review was conducted on patients (aged birth through 18 years) presenting to a PED between January 2015 and December 2015. Eligible subjects included those that had a POC dip, laboratory urinalysis (lab UA), and urine culture performed during their PED visit. Subjects were selected, using a random number generator; 334 charts were selected. A positive POC dip was defined as having a positive leukocyte esterase or the presence of nitrites. A positive lab UA was defined as having a positive leukocyte esterase, nitrites, or greater than 10 white blood cells per high-power field. Urine culture was used as the criterion standard for comparison.
A total of 334 subjects' charts were reviewed. Sensitivity and specificity of the POC dip were 91.4% (95% confidence interval [CI], 76.9%-98.2%) and 63.9% (95% CI, 57.2%-69.3%); lab UA, 91.4% (95% CI, 76.9%-98.2%) and 63.9% (95% CI, 58.2%-69.3%); and lab dip, 88.6% (95% CI, 73.3%-96.8%) and 65.6% (95% CI, 59.9%-70.9%).
Point-of-care dips are as sensitive in detecting UTI as the lab UA. A prospective study could allow for further demographic evaluation of POC dip diagnosed UTI.
即时尿液干化学检测（POC 检测）因快速出结果、价格低廉，在儿科急诊中广泛应用。既往研究显示，手持式尿液干化学检测和自动尿液分析在 48 个月以下儿童中对尿路感染（UTI）有较高的预测价值。推测 POC 检测与实验室尿液分析对 UTI 的诊断准确性相当。
对 2015 年 1 月至 12 月期间在儿科急诊就诊的出生至 18 岁的患者进行回顾性病历分析。合格患者标准为在就诊时同时进行了 POC 检测、实验室尿液分析（lab UA）和尿液培养。使用随机数生成器随机选择 334 例患者。POC 检测阳性定义为白细胞酯酶阳性或亚硝酸盐阳性，lab UA 阳性定义为白细胞酯酶、亚硝酸盐阳性或高倍镜下白细胞计数>10 个。以尿液培养作为对比的金标准。
共分析了 334 例患者的病历。POC 检测的敏感性和特异性分别为 91.4%（95%可信区间 [CI]，76.9%-98.2%）和 63.9%（95% CI，57.2%-69.3%）；lab UA 的敏感性和特异性分别为 91.4%（95% CI，76.9%-98.2%）和 63.9%（95% CI，58.2%-69.3%）；lab 干化学检测的敏感性和特异性分别为 88.6%（95% CI，73.3%-96.8%）和 65.6%（95% CI，59.9%-70.9%）。
POC 检测在诊断 UTI 方面与 lab UA 同样敏感。前瞻性研究可以进一步评估 POC 检测诊断 UTI 的患者人群。
