Diagnostic test accuracy of dipstick urinalysis in clean catch urine for urinary tract infection in febrile infants presenting to emergency departments: a post-hoc analysis of the FIDO study Article Swipe

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Clare Mills , Etimbuk Umana , Nishant Sharma , Thomas Waterfield ·

YOU? · · 2025 · Open Access · · DOI: https://doi.org/10.1016/j.eclinm.2025.103666

Summary: Background: Studies where urine is typically obtained via invasive methods, show dipstick urinalysis can accurately screen for urinary tract infection (UTI) in febrile infants under 90 days old. However, evidence is limited in settings where clean catch urine collection is standard practice. This study assessed the accuracy of dipstick for UTI in a prospective cohort of febrile infants presenting to UK and Ireland emergency departments, where clean catch is the predominant urine collection method. Methods: Post-hoc analysis of the Febrile Infant Diagnostic Assessment and Outcome study, a prospective multicentre observational cohort study. Febrile infants ≤90 days old were recruited from 35 Paediatric Emergency Research in the UK and Ireland (PERUKI) sites (NCT05259683) between 6th July 2022 and the 31st August 2023. Accuracy of dipstick urinalysis testing for detecting UTI was reported with sensitivity, specificity and predictive values. Findings: In this multicentre prospective study of 1821 febrile infants ≤90 days, point-of-care dipstick urinalysis was performed in 57.1% of cases. Diagnostic accuracy varied significantly by age, sex, and method of dipstick assessment. Sensitivity was lowest in neonates (≤28 days; 53.3%) and if dipsticks were user-inspected (57.1%), highlighting limitations in these subgroups. In contrast, automated dipstick testing in infants >28 days achieved high sensitivity (87.5%) and moderate specificity (73.4%) at a cut-off of ≥trace leukocytes and/or ≥trace nitrites. Specificity was notably lower in female infants (60.3%) than males (85.0%), likely due to higher contamination rates in clean catch samples. Interpretation: Automated dipstick urinalysis offers a reliable method for excluding UTI in infants >28 days and can guide selective urine culture use when clean catch urine sampling is used. However, dipstick testing of samples obtained by clean catch should not be used to rule out UTI in neonates or when relying on manual interpretation due to poor sensitivity. Funding: Royal College of Emergency Medicine Doctoral Fellowship (RCEM 02/03/2021), the funders played no part in study conception or design.

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Dipstick Urinalysis Medicine Prospective cohort study Urine Urinary system Emergency department Cohort study Leukocyte esterase Predictive value of tests Voiding cystourethrogram Diagnostic accuracy Cohort Positive predicative value Emergency medicine Pediatrics Physical examination Intensive care medicine Etiology Internal medicine Diagnostic test

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Type: article
Language: en
Landing Page: https://doi.org/10.1016/j.eclinm.2025.103666
OA Status: gold
References: 19
OpenAlex ID: https://openalex.org/W7106286855

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DOI: https://doi.org/10.1016/j.eclinm.2025.103666

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Title: Diagnostic test accuracy of dipstick urinalysis in clean catch urine for urinary tract infection in febrile infants presenting to emergency departments: a post-hoc analysis of the FIDO study

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Language: en

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Publication year: 2025

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Publication date: 2025-11-21

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Authors: Clare Mills, Etimbuk Umana, Nishant Sharma, Thomas Waterfield

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Landing page: https://doi.org/10.1016/j.eclinm.2025.103666

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Concepts: Dipstick, Urinalysis, Medicine, Prospective cohort study, Urine, Urinary system, Emergency department, Cohort study, Leukocyte esterase, Predictive value of tests, Voiding cystourethrogram, Diagnostic accuracy, Cohort, Positive predicative value, Emergency medicine, Pediatrics, Physical examination, Intensive care medicine, Etiology, Internal medicine, Diagnostic test

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abstract_inverted_index.males	225
abstract_inverted_index.rates	232
abstract_inverted_index.sites	111
abstract_inverted_index.study	44, 143, 311
abstract_inverted_index.these	188
abstract_inverted_index.tract	19
abstract_inverted_index.under	25
abstract_inverted_index.urine	4, 38, 72, 256, 262
abstract_inverted_index.used.	265
abstract_inverted_index.where	3, 35, 66
abstract_inverted_index.≤90	95, 148
abstract_inverted_index.(≤28	176
abstract_inverted_index.53.3%)	178
abstract_inverted_index.August	120
abstract_inverted_index.Infant	81
abstract_inverted_index.and/or	213
abstract_inverted_index.cases.	158
abstract_inverted_index.cohort	55, 91
abstract_inverted_index.female	221
abstract_inverted_index.higher	230
abstract_inverted_index.likely	227
abstract_inverted_index.lowest	173
abstract_inverted_index.manual	289
abstract_inverted_index.method	167, 244
abstract_inverted_index.offers	241
abstract_inverted_index.played	307
abstract_inverted_index.screen	16
abstract_inverted_index.should	275
abstract_inverted_index.study,	86
abstract_inverted_index.study.	92
abstract_inverted_index.varied	161
abstract_inverted_index.(60.3%)	223
abstract_inverted_index.(73.4%)	206
abstract_inverted_index.(87.5%)	202
abstract_inverted_index.College	297
abstract_inverted_index.Febrile	80, 93
abstract_inverted_index.Ireland	63, 109
abstract_inverted_index.Outcome	85
abstract_inverted_index.Studies	2
abstract_inverted_index.between	113
abstract_inverted_index.culture	257
abstract_inverted_index.cut-off	209
abstract_inverted_index.design.	314
abstract_inverted_index.febrile	23, 57, 146
abstract_inverted_index.funders	306
abstract_inverted_index.infants	24, 58, 94, 147, 196, 222, 249
abstract_inverted_index.limited	32
abstract_inverted_index.method.	74
abstract_inverted_index.notably	218
abstract_inverted_index.relying	287
abstract_inverted_index.samples	270
abstract_inverted_index.testing	126, 194, 268
abstract_inverted_index.urinary	18
abstract_inverted_index.values.	137
abstract_inverted_index.(57.1%),	184
abstract_inverted_index.(85.0%),	226
abstract_inverted_index.(PERUKI)	110
abstract_inverted_index.Accuracy	122
abstract_inverted_index.Doctoral	301
abstract_inverted_index.Funding:	295
abstract_inverted_index.However,	29, 266
abstract_inverted_index.Medicine	300
abstract_inverted_index.Methods:	75
abstract_inverted_index.Post-hoc	76
abstract_inverted_index.Research	104
abstract_inverted_index.Summary:	0
abstract_inverted_index.accuracy	47, 160
abstract_inverted_index.achieved	199
abstract_inverted_index.analysis	77
abstract_inverted_index.assessed	45
abstract_inverted_index.dipstick	12, 49, 124, 151, 169, 193, 239, 267
abstract_inverted_index.evidence	30
abstract_inverted_index.invasive	9
abstract_inverted_index.methods,	10
abstract_inverted_index.moderate	204
abstract_inverted_index.neonates	175, 284
abstract_inverted_index.obtained	7, 271
abstract_inverted_index.reliable	243
abstract_inverted_index.reported	131
abstract_inverted_index.samples.	236
abstract_inverted_index.sampling	263
abstract_inverted_index.settings	34
abstract_inverted_index.standard	41
abstract_inverted_index.≥trace	211, 214
abstract_inverted_index.Automated	238
abstract_inverted_index.Emergency	103, 299
abstract_inverted_index.Findings:	138
abstract_inverted_index.automated	192
abstract_inverted_index.contrast,	191
abstract_inverted_index.detecting	128
abstract_inverted_index.dipsticks	181
abstract_inverted_index.emergency	64
abstract_inverted_index.excluding	246
abstract_inverted_index.infection	20
abstract_inverted_index.nitrites.	215
abstract_inverted_index.performed	154
abstract_inverted_index.practice.	42
abstract_inverted_index.recruited	99
abstract_inverted_index.selective	255
abstract_inverted_index.typically	6
abstract_inverted_index.Assessment	83
abstract_inverted_index.Diagnostic	82, 159
abstract_inverted_index.Fellowship	302
abstract_inverted_index.Paediatric	102
abstract_inverted_index.accurately	15
abstract_inverted_index.collection	39, 73
abstract_inverted_index.conception	312
abstract_inverted_index.leukocytes	212
abstract_inverted_index.predictive	136
abstract_inverted_index.presenting	59
abstract_inverted_index.subgroups.	189
abstract_inverted_index.urinalysis	13, 125, 152, 240
abstract_inverted_index.Background:	1
abstract_inverted_index.Sensitivity	171
abstract_inverted_index.Specificity	216
abstract_inverted_index.assessment.	170
abstract_inverted_index.limitations	186
abstract_inverted_index.multicentre	89, 141
abstract_inverted_index.predominant	71
abstract_inverted_index.prospective	54, 88, 142
abstract_inverted_index.sensitivity	201
abstract_inverted_index.specificity	134, 205
abstract_inverted_index.02/03/2021),	304
abstract_inverted_index.departments,	65
abstract_inverted_index.highlighting	185
abstract_inverted_index.sensitivity,	133
abstract_inverted_index.sensitivity.	294
abstract_inverted_index.(NCT05259683)	112
abstract_inverted_index.contamination	231
abstract_inverted_index.observational	90
abstract_inverted_index.point-of-care	150
abstract_inverted_index.significantly	162
abstract_inverted_index.interpretation	290
abstract_inverted_index.user-inspected	183
abstract_inverted_index.Interpretation:	237
cited_by_percentile_year
countries_distinct_count	0
institutions_distinct_count	4
citation_normalized_percentile.value	0.91393986
citation_normalized_percentile.is_in_top_1_percent	False
citation_normalized_percentile.is_in_top_10_percent	True