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In children with suspected urinary tract infection (UTI) do rapid tests (dipstick and microscopy) help diagnose infection?
Studies were selected which compared rapid tests (urine dipstick and acute microscopy of urine) in children who presented with UTIs, with the results of urine culture.
Embase and Medline (to July 2009) were searched along with reference lists. Hungarian, Japanese, Finnish and Turkish papers were not translated. The quality of studies was assessed by modified QUADAS criteria; 95 studies were included.
The 95 studies included 95 703 patients, and undertook 12 different test comparisons. Masking of study investigators was unclear in most cases, and many had poor descriptions of test or reference study procedures. Sixty-eight of 95 studies were in unrepresentative (asymptomatic or specialist service) settings. Definitions (n) of test thresholds were heterogeneous for white cell count (n=7), bacterial microscopy (n=5) and leucocyte esterase (n=3). Meta-analysis showed that microscopy for bacteria was the most accurate (preferably with gram staining) approach, with ‘either leucocyte esterase or nitrite positivity’ being the …
Sources of funding Australian NHMRC project and programme grants.
Competing interests None.
Provenance and peer review Commissioned; internally peer reviewed.