The validity of clinical features and urinalysis in diagnosing urinary tract infection among children
Dr. Ammar H Yahia, Samim A Al-Dabbagh, Dr. Abd Al-Munaf Abdulraheem
Urinary tract infection is a common disease with a variable clinical presentation during infancy and childhood. It may carry serious consequences unless prompt and accurate diagnosis and treatment are carried out early in the disease. The aim of the present study is to assess the validity of clinical symptoms, signs, and urinalysis in diagnosing UTI among children above two years of age. A sample of 150 children aged 2 – 15 years from both sexes, who were attending Ibn Al-Atheer pediatric hospital in Mosul city at the outpatient department, were enrolled in the study. Children were included if they were suspected to have UTI on clinical bases by a specialist pediatrician. Each one of those children was evaluated for the presence of the classical symptoms and signs of UTI which were recorded using a specially designed questionnaire form. A similar number of healthy children from the same age group attending the same setting (for vaccination or accompanying their relative patients visiting the hospital) were also enrolled in the study as a comparison group. A fresh urine sample was collected from each child and sent to the hospital laboratory where urinalysis and culture were performed on this sample. Results of urine culture were used as a gold standard for the diagnosis of UTI. Sensitivity, specificity, predictive values, and likelihood ratios were estimated for each clinical criterion including the elements of urinalysis. Urinary tract infection was diagnosed by urine culture in 58 (19.3%) patients, 50 (86.2%) were females and 8 (13.8%) were males giving a male to female ratio of [0.16: 1]. The clinical features showed a good sensitivity in diagnosing UTI (93.1%) with a low specificity (60.3%). Urinalysis was found to have a lower sensitivity than the clinical features (77.6%) but a higher specificity (75.2%). Dysuria was the best single predictor of UTI with a sensitivity of (70.7%) and a specificity of (73%). Among the elements of urinalysis, pyuria was found to be the best indicator of UTI with a sensitivity of 77.6% and specificity of 75.2%. The absence of the three criteria: dysuria, frequency, and pyuria had ruled out UTI effectively. The sensitivity of this combination was (96.6%). Presence of fever, cloudy urine, and bacteriuria simultaneously were adequate to rule in the disease. This study suggests that using clinical criteria in combination could improve the performance of physicians in diagnosing UTI among children.