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Test characteristics of tests used to diagnose urinary tract infections in children

Test characteristics of tests used to diagnose urinary tract infections in children
  Sensitivity Specificity Positive likelihood ratio* Negative likelihood ratio
Dipstick
LE 84% 78% 4 0.2
Nitrite 50% 98% 25 0.5
Nitrite or LE 88% 93% 13 0.1
Nitrite and LE 72% 96% 18 0.3
Microscopy
Uncentrifuged
Pyuria (>10/mm3) (all ages) 77% 89% 7 0.4
Pyuria (>10/mm3) (<2 years) 90% 95% 18 0.1
Bacteriuria (Gram-stained) 93% 95% 19 0.1
Overall (P+B) = enhanced 85% 99.9% 85 0.1
Overall (P or B) 95% 89% 9 0.1
Centrifuged
Pyuria (>5/hpf) 67% 79% 3 0.4
Bacteriuria 81% 83% 5 0.2
Overall (P+B) 66% 99% 7 0.4
LE: leukocyte esterase; P: pyuria; B: bacteriuria; hpf: high-power field.
* Positive likelihood ratio: The positive likelihood ratio is the probability that a child with a UTI will have a positive test divided by the probability that a child without a UTI will have a positive test (eg, true positive rate/false positive rate). The higher the positive likelihood ratio, the better the test.
¶ Negative likelihood ratio: The negative likelihood ratio is the probability that a child with a UTI will have a negative test divided by the probability that a child without a UTI will have a negative test (eg, false negative rate/true negative rate). The lower the negative likelihood ratio, the better the test (a perfect test has a negative likelihood ratio of zero).
References:
  1. Gorelick MH, Shaw KN. Screening tests for urinary tract infection in children: A meta-analysis. Pediatrics 1999; 104:e54.
  2. Huicho L, Campos-Sanchez M, Alamo C. Metaanalysis of urine screening tests for determining the risk of urinary tract infection in children. Pediatr Infect Dis J 2002; 21:1.
  3. Finnell SM, Carroll AE, Downs SM, the Subcommittee on Urinary Tract Infection. Technical report--Diagnosis and management of an initial UTI in febrile infants and young children. Pediatrics 2011; 128:e749. 
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