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Evaluation of the accuracy of leukocyte esterase
testing to detect pyuria in young febrile children: prospective
study
SF Yuen, FN Ng, LY So
Department of Paediatrics, Pamela Youde Nethersole Eastern Hospital,
3 Lok Man Road, Chai Wan, Hong Kong
OBJECTIVE. To study the accuracy and clinical application
of the dipstick leukocyte esterase test in the detection of pyuria
in young febrile children suspected to have urinary tract infection.
DESIGN. Prospective study.
SETTING. Regional hospital, Hong Kong.
PATIENTS. Urine samples were taken from 215 children younger than
2 years who were suspected to have urinary tract infection (fever
without an obvious focus of infection).
MAIN OUTCOME MEASURES. The accuracy of the dipstick leukocyte esterase
test in detecting significant pyuria defined as a leukocyte count
>/=10 mm3 (>/=0.01 x 107 /L).
RESULTS. Two hundred and fifty-four urine samples collected by bag,
midstream clean-catch, suprapubic bladder aspiration, or urethral
catheterization were examined. Using urine microscopy results as
a reference, the sensitivity and specificity of the leukocyte esterase
test in detecting significant pyuria were found to be 72.0% and
85.8%, respectively; the positive and negative predictive values
were 55.4% and 92.6%, respectively; and the positive and negative
likelihood ratios were 5.1 and 0.3, respectively.
CONCLUSIONS. The dipstick leukocyte esterase test cannot accurately
detect pyuria in young febrile children. It is also not appropriate
as a screening test to exclude pyuria, reduce the need for the microscopic
examination of urine, or indicate when a hospital admission for
probable urinary tract infection is needed.
Hong Kong Med J 2001;7:5-8
Key words: Child; Pyuria/diagnosis; Reagent strips;
Sensitivity and specificity; Urinalysis; Urinary tract infections
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