Laura Hauge Kristensen, Rannva Winther, Josefine Tvede Colding-Jørgensen, Anton Pottegård, Henrik Nielsen, Jacob Bodilsen
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Positive dipsticks were defined as any reaction for leucocyte esterase and/or nitrite.</p><p><strong>Results: </strong>Dipsticks were used in 1052/2495 (42%) of acutely hospitalised patients with a median age of 73 years (IQR 57-82) and 540 (51%) were female. Overall, 89/1052 (8%) fulfilled the UTI criteria and urine cultures were done in 607/1052 (58%) patients. Among patients examined with both dipstick and urine culture, sensitivity and specificity for UTI were 87% (95% CI 78% to 93%) and 45% (95% CI 41% to 50%). Positive and negative predictive values were 21% (95% CI 17% to 26%) and 95% (95% CI 92% to 98%), whereas positive and negative likelihood ratios were 1.58 (95% CI 1.41 to 1.77) and 0.30 (95% CI 0.18 to 0.51). Pretest probabilities of UTI ranged from 29% to 60% in participants with specific UTI symptoms with corresponding post-test probabilities of 35-69% if dipsticks were positive and 12-27% if dipsticks were negative. Results remained comparable if final clinical diagnosis was used as outcome among all patients examined with dipsticks. Modified Poisson regression yielded an adjusted relative risk of 4.41 (95% CI 2.40 to 8.11) for empirical antibiotics for UTI in participants without specific UTI symptoms and a positive dipstick.</p><p><strong>Conclusions: </strong>Dipsticks yielded limited clinical decision support compared with a symptom-driven approach in this study and were independently associated with excess antibiotics for UTI.</p>","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":"36-44"},"PeriodicalIF":9.0000,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Diagnostic accuracy of dipsticks for urinary tract infections in acutely hospitalised patients: a prospective population-based observational cohort study.\",\"authors\":\"Laura Hauge Kristensen, Rannva Winther, Josefine Tvede Colding-Jørgensen, Anton Pottegård, Henrik Nielsen, Jacob Bodilsen\",\"doi\":\"10.1136/bmjebm-2024-112920\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To determine the added diagnostic value of dipsticks for urinary tract infections (UTI) in acutely hospitalised individuals.</p><p><strong>Design: </strong>Prospective population-based cohort study.</p><p><strong>Setting: </strong>North Denmark.</p><p><strong>Participants: </strong>All adults (≥18 years) examined with dipsticks at emergency departments in North Denmark Region from September 20 through 23 October 2021.</p><p><strong>Main outcome measures: </strong>UTI was defined as ≥1 symptom of new-onset frequency, dysuria or suprapubic tenderness combined with a positive urine culture. Positive dipsticks were defined as any reaction for leucocyte esterase and/or nitrite.</p><p><strong>Results: </strong>Dipsticks were used in 1052/2495 (42%) of acutely hospitalised patients with a median age of 73 years (IQR 57-82) and 540 (51%) were female. Overall, 89/1052 (8%) fulfilled the UTI criteria and urine cultures were done in 607/1052 (58%) patients. Among patients examined with both dipstick and urine culture, sensitivity and specificity for UTI were 87% (95% CI 78% to 93%) and 45% (95% CI 41% to 50%). Positive and negative predictive values were 21% (95% CI 17% to 26%) and 95% (95% CI 92% to 98%), whereas positive and negative likelihood ratios were 1.58 (95% CI 1.41 to 1.77) and 0.30 (95% CI 0.18 to 0.51). Pretest probabilities of UTI ranged from 29% to 60% in participants with specific UTI symptoms with corresponding post-test probabilities of 35-69% if dipsticks were positive and 12-27% if dipsticks were negative. Results remained comparable if final clinical diagnosis was used as outcome among all patients examined with dipsticks. 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引用次数: 0
摘要
目的：确定浸渍棒对急性住院病人尿路感染（UTI）的附加诊断价值：确定浸渍棒对急性住院病人尿路感染（UTI）的附加诊断价值：前瞻性人群队列研究：地点：丹麦北部：2021年9月20日至10月23日期间在北丹麦大区急诊科使用滴定管检查的所有成年人（≥18岁）：UTI的定义是：新发尿频、排尿困难或耻骨上压痛症状≥1个，且尿培养呈阳性。结果：1052 名患者使用了浸渍棒检测尿液中的白细胞酯酶和/或亚硝酸盐：1052/2495（42%）名急性住院患者使用了滴定管，中位年龄为 73 岁（IQR 57-82），其中 540 名（51%）为女性。总体而言，89/1052（8%）例患者符合尿毒症标准，607/1052（58%）例患者进行了尿培养。在同时接受量尺和尿培养检查的患者中，尿毒症的敏感性和特异性分别为 87% (95% CI 78% 至 93%) 和 45% (95% CI 41% 至 50%)。阳性和阴性预测值分别为 21% (95% CI 17% 至 26%) 和 95% (95% CI 92% 至 98%)，阳性和阴性似然比分别为 1.58 (95% CI 1.41 至 1.77) 和 0.30 (95% CI 0.18 至 0.51)。在具有特定 UTI 症状的参与者中，测试前的 UTI 概率为 29% 至 60%，如果滴管呈阳性，则测试后的相应概率为 35% 至 69%，如果滴管呈阴性，则概率为 12% 至 27%。如果将最终临床诊断作为所有使用滴管检查的患者的结果，结果仍具有可比性。修正泊松回归结果显示，在没有特定UTI症状且量尺呈阳性的参与者中，使用经验性抗生素治疗UTI的调整相对风险为4.41（95% CI为2.40至8.11）：在本研究中，与以症状为导向的方法相比，浸量尺只能提供有限的临床决策支持，而且与UTI抗生素用量过多有独立关联。
Diagnostic accuracy of dipsticks for urinary tract infections in acutely hospitalised patients: a prospective population-based observational cohort study.
Objective: To determine the added diagnostic value of dipsticks for urinary tract infections (UTI) in acutely hospitalised individuals.
Participants: All adults (≥18 years) examined with dipsticks at emergency departments in North Denmark Region from September 20 through 23 October 2021.
Main outcome measures: UTI was defined as ≥1 symptom of new-onset frequency, dysuria or suprapubic tenderness combined with a positive urine culture. Positive dipsticks were defined as any reaction for leucocyte esterase and/or nitrite.
Results: Dipsticks were used in 1052/2495 (42%) of acutely hospitalised patients with a median age of 73 years (IQR 57-82) and 540 (51%) were female. Overall, 89/1052 (8%) fulfilled the UTI criteria and urine cultures were done in 607/1052 (58%) patients. Among patients examined with both dipstick and urine culture, sensitivity and specificity for UTI were 87% (95% CI 78% to 93%) and 45% (95% CI 41% to 50%). Positive and negative predictive values were 21% (95% CI 17% to 26%) and 95% (95% CI 92% to 98%), whereas positive and negative likelihood ratios were 1.58 (95% CI 1.41 to 1.77) and 0.30 (95% CI 0.18 to 0.51). Pretest probabilities of UTI ranged from 29% to 60% in participants with specific UTI symptoms with corresponding post-test probabilities of 35-69% if dipsticks were positive and 12-27% if dipsticks were negative. Results remained comparable if final clinical diagnosis was used as outcome among all patients examined with dipsticks. Modified Poisson regression yielded an adjusted relative risk of 4.41 (95% CI 2.40 to 8.11) for empirical antibiotics for UTI in participants without specific UTI symptoms and a positive dipstick.
Conclusions: Dipsticks yielded limited clinical decision support compared with a symptom-driven approach in this study and were independently associated with excess antibiotics for UTI.
期刊介绍：
BMJ Evidence-Based Medicine (BMJ EBM) publishes original evidence-based research, insights and opinions on what matters for health care. We focus on the tools, methods, and concepts that are basic and central to practising evidence-based medicine and deliver relevant, trustworthy and impactful evidence.
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