Is positive dipstick alone enough to identify the cause as infective in patients with dysuria and haematuria?

Date First Published:

July 6, 2005

Last Updated:

July 15, 2005

Report by:

Philippa McCaffrey, 4th Year Medical Student (Manchester Royal Infirmary)

Search checked by:

Philippa McCaffrey, Manchester Royal Infirmary

Three-Part Question:

In [adults with dysuria and haematuria] is [positive dipstick without urine microscopy as good as positive dipstick with urine microscopy] at [identifying the cause as infective]?

Clinical Scenario:

A 33 year old lady who has had cystitis before presents to the Emergency Department with pain on passing urine. Urine dipstick reveals haematuria. You wonder if it is necessary to send a sample for microscopy or whether you can assume the cause is infective and treat blind with empirical antibiotics.

Search Strategy:

Medline using the OVID interface - 1966 to June Week 1 2005
Embase - 1980 to 2005 Week 24
CINAHL - 1982 to June Week 1 2005
Cochrane Library - Issue 2 2005

Search Details:

(exp. HEMATURIA OR haematuria.mp) AND (exp. Urination Disorders/ or DYSURIA.mp. or exp. Urinary Tract Infections/) AND (MSU.mp. OR MIDSTREAM URINE.mp. OR exp. URINALYSIS/ OR exp Microscopy/ or URINE MICROSCOPY.mp. OR exp Reagent Strips/ or URINE DIPSTICK.mp.)
Limit to (Humans, English Language, Adults (19 and over))

Outcome:

Medline - 67 papers found of which 2 were relevant
Embase - no additional relevant papers
CINAHL - no additional relevant papers
Cochrane Library - no additional relevant papers

Relevant Paper(s):

Study Title	Patient Group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Comparison of Test Characteristics of Urine Dipstick and Urinalysis at Various Test Cutoff Points Lammers RL, Gibson S, Kovacs D, Sears W, Strachan G 2001 USA	Adult women presenting to 1 of 2 community hospital EDs or an intermediate care centre with symptoms suggestive of a UTI (343 patients in total). Average age 33 (range 18-84). Positive urine culture was taken as Gold Standard.	Prospective observational cohort study	Dipstick	Sensitivity 96%	Women only. Not all patients presenting during the study period were included causing possible sampling error. No continuity in distick technique.
			Microscopy	Specificity 27%
				NPV 87%
				PPV 53%
				Sensitivity 95%
				Specificity 36%
				NPV 87%
				PPv 56%
Utility of dipstick urinalysis as a guide to management of adults with suspected infection or hematuria Jou WW, Powers RD 1998 USA	Random sample of adult ED patients who had microscopic urinaysis ordered for detection of possible UTI or haematuria or both, following a positive dipstick. 166 patients in total, collected in 25 consecutive 8 hour sessions. Average age 45 years (range 18-97). 112 women, 54 men. Microscopy was used to confirm or ngate diagnosis.	Randomised prospective cohort study	Total number of patients where results of microscopy altered management plan made on basis of dipstick result	9/166 (5.4%)	Study not blinded. Care providers were aware that their behavoiur was being observed - this may have altered their clinical decision-making. Small sample size of patients investigated for haematuria.

Author Commentary:

Both tests can be seen to have definite limitations in their diagnostic accuracy. The conclusion drawn seems to be dependent on the particular clinical situation.

Bottom Line:

In adult patients presenting to the Emergency Department with haematuria and symptoms suggestive of a UTI a positive dipstick result is adequate to assist a clinical treatment decision.

References:

Lammers RL, Gibson S, Kovacs D, Sears W, Strachan G. Comparison of Test Characteristics of Urine Dipstick and Urinalysis at Various Test Cutoff Points
Jou WW, Powers RD. Utility of dipstick urinalysis as a guide to management of adults with suspected infection or hematuria