Tags

Type your tag names separated by a space and hit enter

The prognostic value of dipstick urinalysis in children admitted to hospital with severe malnutrition.
Arch Dis Child. 2010 Jun; 95(6):422-6.AD

Abstract

BACKGROUND

Children with severe malnutrition (SAM) present to hospital with an array of complications, resulting in high mortality despite adherence to WHO guidelines. Diagnostic resources in developing countries are limited and bedside tests could help identify high-risk children. Dipstick urinalysis is a bedside screening test for urinary tract infections (UTIs). UTIs are common in SAM and can lead to secondary invasive bacterial sepsis. Very few studies have examined the usefulness of dipstick screening of urine specimens in SAM and none has explored its prognostic value.

PATIENTS AND METHODS

A 2-year prospective study on children admitted in Kilifi District Hospital, Kenya, with SAM. Freshly voided, clean catch urine samples were tested using Multistix reagent test strips. Positive samples were sent for culture.

RESULTS

Of the 667 children admitted, 498 children (75%) provided urine samples; of these, 119 (24%) were positive for either leucocyte esterase (LE) or nitrites. Culture-proven UTI was detected in 28 children (6% overall). All isolates were coliforms and were >50% were resistant to cotrimoxazole and gentamicin. There was no difference in severity signs between those with positive dipstick and those without. Case fatality was higher among children with a positive dipstick (29% vs 12%). Presence of a positive dipstick was a strong predictor of mortality (adjusted HR 2.5).

CONCLUSIONS

A urine dipstick positive for either LE or nitrites is a useful predictor of death in children admitted with SAM. Prospective studies to determine the role of untreated UTI in these deaths are needed before any treatment recommendations can be made.

Links

Publisher Full Text
Aggregator Full Text

Authors+Show Affiliations

Thuo N
Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute, Kilifi, Kenya. nthuo@kilifi.kemri-wellcome.org
Ohuma E
No affiliation info available
Karisa J
No affiliation info available
Talbert A
No affiliation info available
Berkley JA
No affiliation info available
Maitland K
No affiliation info available

MeSH

BiomarkersCarboxylic Ester HydrolasesChild, PreschoolEpidemiologic MethodsFemaleHospitalizationHumansInfantMaleMalnutritionNitritesOpportunistic InfectionsPrognosisReagent StripsUrinary Tract Infections

Pub Type(s)

Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20371590

Clinical Trial Links

Biomedical Investigations for Optimized Diagnosis and Monitoring of Severe Acute Malnutrition (SAM): Elucidating the Heterogeneous Diagnosis of SAM by Current Anthropometric Criteria and Moving Beyond

Citation

Thuo, Nahashon, et al. "The Prognostic Value of Dipstick Urinalysis in Children Admitted to Hospital With Severe Malnutrition." Archives of Disease in Childhood, vol. 95, no. 6, 2010, pp. 422-6.
Thuo N, Ohuma E, Karisa J, et al. The prognostic value of dipstick urinalysis in children admitted to hospital with severe malnutrition. Arch Dis Child. 2010;95(6):422-6.
Thuo, N., Ohuma, E., Karisa, J., Talbert, A., Berkley, J. A., & Maitland, K. (2010). The prognostic value of dipstick urinalysis in children admitted to hospital with severe malnutrition. Archives of Disease in Childhood, 95(6), 422-6. https://doi.org/10.1136/adc.2009.168211
Thuo N, et al. The Prognostic Value of Dipstick Urinalysis in Children Admitted to Hospital With Severe Malnutrition. Arch Dis Child. 2010;95(6):422-6. PubMed PMID: 20371590.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The prognostic value of dipstick urinalysis in children admitted to hospital with severe malnutrition. AU - Thuo,Nahashon, AU - Ohuma,Eric, AU - Karisa,Japhet, AU - Talbert,Alison, AU - Berkley,James A, AU - Maitland,Kathryn, Y1 - 2010/04/06/ PY - 2010/4/8/entrez PY - 2010/4/8/pubmed PY - 2010/8/24/medline SP - 422 EP - 6 JF - Archives of disease in childhood JO - Arch Dis Child VL - 95 IS - 6 N2 - BACKGROUND: Children with severe malnutrition (SAM) present to hospital with an array of complications, resulting in high mortality despite adherence to WHO guidelines. Diagnostic resources in developing countries are limited and bedside tests could help identify high-risk children. Dipstick urinalysis is a bedside screening test for urinary tract infections (UTIs). UTIs are common in SAM and can lead to secondary invasive bacterial sepsis. Very few studies have examined the usefulness of dipstick screening of urine specimens in SAM and none has explored its prognostic value. PATIENTS AND METHODS: A 2-year prospective study on children admitted in Kilifi District Hospital, Kenya, with SAM. Freshly voided, clean catch urine samples were tested using Multistix reagent test strips. Positive samples were sent for culture. RESULTS: Of the 667 children admitted, 498 children (75%) provided urine samples; of these, 119 (24%) were positive for either leucocyte esterase (LE) or nitrites. Culture-proven UTI was detected in 28 children (6% overall). All isolates were coliforms and were >50% were resistant to cotrimoxazole and gentamicin. There was no difference in severity signs between those with positive dipstick and those without. Case fatality was higher among children with a positive dipstick (29% vs 12%). Presence of a positive dipstick was a strong predictor of mortality (adjusted HR 2.5). CONCLUSIONS: A urine dipstick positive for either LE or nitrites is a useful predictor of death in children admitted with SAM. Prospective studies to determine the role of untreated UTI in these deaths are needed before any treatment recommendations can be made. SN - 1468-2044 UR - https://www.unboundmedicine.com/medline/citation/20371590/The_prognostic_value_of_dipstick_urinalysis_in_children_admitted_to_hospital_with_severe_malnutrition_ L2 - https://adc.bmj.com/lookup/pmidlookup?view=long&pmid=20371590 DB - PRIME DP - Unbound Medicine ER -