Enhanced Urinalysis in Febrile Children with Suspected Urinary Tract Infection

Objective: To study the results of enhanced urinalysis in febrile children with suspected urinary tract infection and to compare the results of enhanced urinalysis with standard urinalysis. Methods: Febrile children between one month to 18 years of age with clinical features suggestive of urinary tract infection or with unexplained fever, attending department of paediatrics formed the subjects of the study. Standard and enhanced urinalysis were performed in all the cases. For enhanced urinalysis a drop of fresh unspun and unstained urine was placed on an improved Neubaur haemocytometer and examined under high dry magnification for the presence of pyuria (reported as wbc/cumm). Urine specimens were also sent for culture tests. Results: Total of 253 children were included in the study of whom 148 were males and 105 were females. Mean age was 3.6 years. Culture was positive in 42 specimens. Out of 39 cases who had significant pyuria by standard urinalysis, 28 (71%) were found to be culture positive. Where as out of 50 cases who had significant pyuria by enhanced urinalysis, 38(76%) had positive urine culture. However out of 214 cases negative for pyuria by standard method, fourteen (6.5%) cases were culture positive. For almost same number of pyuria negative cases by enhanced method (203), only 4 cases (1.9%) were culture positive. Accordingly enhanced urinalysis showed higher sensitivity (90% Vs 66%) with a greater positive predictive value (76% Vs 71.8%) when compared to standard urinalysis. Conclusion: Enhanced urinalysis has a greater sensitivity and positive predictive value compared to standard urinalysis in children with urinary tract infections and a negative enhanced urinalysis almost rules out UTI (negative predictive value - 97.5%).