Diagnostic Accuracy of Urinary Reagent Strip Applied to Cerebrospinal Fluid Analysis for the Detection of Bacterial Meningitis in Children.

Abstract

Bacterial meningitis is a medical emergency in children and requires early diagnosis and prompt treatment to reduce mortality and neurological complications. In resource-limited settings, urinary reagent strips applied to Cerebrospinal fluid (CSF) may offer a rapid bedside alternative for preliminary diagnosis. This study aimed to assess the diagnostic accuracy of urinary reagent strip testing in CSF analysis for the detection of bacterial meningitis in children, compared with standard laboratory methods. This cross-sectional descriptive study was conducted in the Department of Paediatrics, Mymensingh Medical College Hospital, Bangladesh from June 2024 to August 2025. A total of 82 children aged 1 month to 12 years with clinical features suggestive of meningitis were enrolled by purposive sampling. Urinary reagent strip test results showed highly significant association with laboratory CSF findings for glucose, protein and leukocytes (p<0.001) and also with CSF culture (p<0.001). The sensitivity, specificity, PPV and NPV of strip CSF glucose were 89.3%, 61.1%, 54.3% and 91.7%; of strip CSF protein were 96.4%, 44.4%, 47.4% and 96.0%; and of strip CSF leukocytes were 92.9%, 57.4%, 53.1% and 93.9%, respectively. ROC analysis demonstrated good diagnostic accuracy, with area under the curve (AUC) values of 0.752 for strip CSF glucose, 0.704 for strip CSF protein and 0.779 for strip CSF leukocytes. Urinary reagent strip testing of CSF showed good diagnostic accuracy in children with suspected meningitis. It showed high sensitivity and high negative predictive value with significant agreement with standard laboratory findings and CSF culture. Therefore, it may be used as a rapid bedside screening tool, especially in emergency and resource-limited settings, although it cannot replace conventional laboratory analysis and CSF culture for definitive diagnosis.