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Nappy pad urine samples for investigation and treatment of UTI in young children: the 'DUTY' prospective diagnostic cohort study

Butler, Christopher C., Sterne, Jonathan A. C., Lawton, Michael, O'Brien, Kathryn, Wootton, Mandy, Hood, Kerenza, Hollingworth, William, Little, Paul, Delaney, Brendan C., Van Der Voort, Judith, Dudley, Jan, Birnie, Kate, Pickles, Timothy, Waldron, Cherry-Ann, Downing, Harriet, Thomas-Jones, Emma, Lisles, Catherine, Rumsby, Kate, Durbaba, Stevo, Whiting, Penny, Harman, Kim, Howe, Robin, MacGowan, Alasdair, Fletcher, Margaret and Hay, Alastair D. 2016. Nappy pad urine samples for investigation and treatment of UTI in young children: the 'DUTY' prospective diagnostic cohort study. British Journal of General Practice 66 (648) , e516-e524. 10.3399/bjgp16X685873

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Background The added diagnostic utility of nappy pad urine samples and the proportion that are contaminated is unknown. Aim To develop a clinical prediction rule for the diagnosis of urinary tract infection (UTI) based on sampling using the nappy pad method. Design and setting Acutely unwell children <5 years presenting to 233 UK primary care sites. Method Logistic regression to identify independent associations of symptoms, signs, and urine dipstick test results with UTI; diagnostic utility quantified as area under the receiver operator curves (AUROC). Nappy pad rule characteristics, AUROC, and contamination, compared with findings from clean-catch samples. Results Nappy pad samples were obtained from 3205 children (82% aged <2 years; 48% female), culture results were available for 2277 (71.0%) and 30 (1.3%) had a UTI on culture. Female sex, smelly urine, darker urine, and the absence of nappy rash were independently associated with a UTI, with an internally-validated, coefficient model AUROC of 0.81 (0.87 for clean-catch), which increased to 0.87 (0.90 for clean-catch) with the addition of dipstick results. GPs’ ‘working diagnosis’ had an AUROC 0.63 (95% confidence intervals [CI] = 0.53 to 0.72). A total of 12.2% of nappy pad and 1.8% of clean-catch samples were ‘frankly contaminated’ (risk ratio 6.66; 95% CI = 4.95 to 8.96; P<0.001). Conclusion Nappy pad urine culture results, with features that can be reported by parents and dipstick tests, can be clinically useful, but are less accurate and more often contaminated compared with clean-catch urine culture.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Subjects: R Medicine > RJ Pediatrics
Publisher: Royal College of General Practitioners
ISSN: 0960-1643
Funders: HTA
Date of First Compliant Deposit: 20 November 2017
Date of Acceptance: 25 February 2016
Last Modified: 15 Oct 2021 02:42

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