POINT-OF-CARE TESTS FOR PEDIATRIC URINARY TRACT INFECTIONS: SYSTEMATIC REVIEW AND META-ANALYSIS
Author(s)
Lara Gerhardt, MSc1, Omar Irfan, MD1, Liga Bennetts, PhD2, Syed Ahmed Raza, MSc1, Gabriela Friedrich, MSc3, Pauline Le Nouveau, MSc4, Brenda Rattanavong, PharmD2, Da Eun Ahn, MSc5, Shaun Morris, MD, MPH, FRCPC, FAAP, DTM&H6;
1Amaris Consulting, Toronto, ON, Canada, 2Amaris Consulting, Montreal, QC, Canada, 3Amaris Consulting, Barcelona, Spain, 4Amaris Consulting, Nantes, France, 5Amaris Consulting, London, United Kingdom, 6The Hospital for Sick Children, Toronto, ON, Canada
1Amaris Consulting, Toronto, ON, Canada, 2Amaris Consulting, Montreal, QC, Canada, 3Amaris Consulting, Barcelona, Spain, 4Amaris Consulting, Nantes, France, 5Amaris Consulting, London, United Kingdom, 6The Hospital for Sick Children, Toronto, ON, Canada
OBJECTIVES: Urinary tract infections (UTIs) are common in children. The gold standard diagnostic test is urine culture; however, this test requires specific sample types and collection methods, clinical laboratory resources and takes 24-48 hours. Point-of-care tests (POCTs) are fast and informative, especially in resource-constrained settings. Conduct a systematic literature review and meta-analysis to determine the diagnostic accuracy of POCTs for UTIs in children with suspected UTI (PROSPERO: CRD42023474006).
METHODS: Electronic databases were searched in August-September 2023 from inception, supplemented with searches of registries and other sources. Two reviewers screened studies reporting diagnostic accuracy measures for POCTs compared with urine culture in pediatric patients. Data was extracted. Methodological quality was assessed by two reviewers using QUADAS-2. Random-effects meta-analysis was used to generate pooled estimates for a POCT when reported by ≥3 studies. Certainty of evidence (CoE) for pooled estimates was determined using Grading of Recommendations, Assessment, Development and Evaluation (GRADE).
RESULTS: Included 68 observational studies assessing diagnostic accuracy of 28 POCTs for UTIs in children compared to urine culture. Sensitivity and specificity of 8 POCTs were included in meta-analyses; CoE was moderate to very low. The highest diagnostic accuracy was identified with dipstick leukocyte esterase (LE) or nitrite (i.e., test considered positive when at least one test component was positive; sensitivity 87.4%) and dipstick LE (sensitivity 81.0%).
CONCLUSIONS: Evidence supports using dipstick LE or dipstick LE or nitrite for potential UTIs in children. Substantial heterogeneity was observed in most meta-analyses.
METHODS: Electronic databases were searched in August-September 2023 from inception, supplemented with searches of registries and other sources. Two reviewers screened studies reporting diagnostic accuracy measures for POCTs compared with urine culture in pediatric patients. Data was extracted. Methodological quality was assessed by two reviewers using QUADAS-2. Random-effects meta-analysis was used to generate pooled estimates for a POCT when reported by ≥3 studies. Certainty of evidence (CoE) for pooled estimates was determined using Grading of Recommendations, Assessment, Development and Evaluation (GRADE).
RESULTS: Included 68 observational studies assessing diagnostic accuracy of 28 POCTs for UTIs in children compared to urine culture. Sensitivity and specificity of 8 POCTs were included in meta-analyses; CoE was moderate to very low. The highest diagnostic accuracy was identified with dipstick leukocyte esterase (LE) or nitrite (i.e., test considered positive when at least one test component was positive; sensitivity 87.4%) and dipstick LE (sensitivity 81.0%).
CONCLUSIONS: Evidence supports using dipstick LE or dipstick LE or nitrite for potential UTIs in children. Substantial heterogeneity was observed in most meta-analyses.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EPH32
Topic
Epidemiology & Public Health
Topic Subcategory
Public Health
Disease
SDC: Pediatrics, SDC: Urinary/Kidney Disorders