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

Nappy pad urine samples for investigation and treatment of UTI in young children: the ‘DUTY’ prospective diagnostic cohort study
Nappy pad urine samples for investigation and treatment of UTI in young children: the ‘DUTY’ prospective diagnostic cohort study
Background: although sampling urine using nappy pads is preferred by parents and recommended when a clean catch sample can’t be obtained, we do not know the added diagnostic utility of ‘nappy pad’ urine samples, nor the proportion that are contaminated.

Setting: acutely unwell children <5 years presenting to 233 primary care sites in England and Wales.

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 to findings from clean catch samples.

Results: nappy pad samples were obtained from 3205 children (82% <2 years; 48% female), and culture results available for 2277 (71.0%). 30 (1.3%) met our laboratory definition of UTI. Female gender, smelly urine, darker urine, and absence of nappy rash were independently associated with UTI, with an internally validated, coefficient model AUROC of 0.81 (0.87 for clean catch) that increased to 0.87 (0.90 for clean catch) with the addition of dipstick results. GPs’ ‘working diagnosis’ had an AUROC 0.63 (95% CI 0.53 to 0.72). 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 to clean catch urine culture results, which should be prioritised. Dipstick testing adds diagnostic accuracy.


antibacterial agents, diagnosis, infant, paediatrics, primary health care, urinary tract infections
0960-1643
e516-e524
Butler, Christopher
8bf4cace-c34a-4b65-838f-29c2be91e434
Sterne, Jonathan
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Lawton, Michael
07a580cf-fdcb-42d7-b5cc-0dbe942f801d
OBrien, Kathryn
f255cf29-e272-46f7-9290-dd1d06b0dbde
Wootten, Mandy
873f91ee-c20d-4685-95aa-88cab411f154
Hood, Kerenza
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Holllingworth, William
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Little, Paul
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Delaney, Brendan
faccda65-7adf-4e79-b97a-b79814a016fd
Van der Voort, Judith
d35b2ed1-6e26-4d2e-aa21-62cc637e78e6
Dudley, Jan
d9caef7d-0a8b-4879-839e-43f347228c5e
Birnie, Kate
54214a2e-da4d-4b30-bb1f-7d74ea85bbf6
PIckles, Timothy
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Waldron, Cherry-Ann
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Dowinng, Harriet
125ae677-2ad1-4667-9630-4d132664121d
Emma, Thomas-Jones
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Lisles, Catherine
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Rumsby, Kate
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Durbaba, Steve
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Whiting, Penny
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Harman, Kim
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Howe, Robin
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MacGowan, Alasdair
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Fletcher, Margaret
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Hay, Alastair
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Butler, Christopher
8bf4cace-c34a-4b65-838f-29c2be91e434
Sterne, Jonathan
05fbcb78-68a6-4461-815e-e1f555602bd5
Lawton, Michael
07a580cf-fdcb-42d7-b5cc-0dbe942f801d
OBrien, Kathryn
f255cf29-e272-46f7-9290-dd1d06b0dbde
Wootten, Mandy
873f91ee-c20d-4685-95aa-88cab411f154
Hood, Kerenza
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Holllingworth, William
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Little, Paul
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Delaney, Brendan
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Van der Voort, Judith
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Dudley, Jan
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Birnie, Kate
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PIckles, Timothy
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Waldron, Cherry-Ann
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Dowinng, Harriet
125ae677-2ad1-4667-9630-4d132664121d
Emma, Thomas-Jones
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Lisles, Catherine
0514613b-8a65-4d99-b687-288395f0e73d
Rumsby, Kate
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Durbaba, Steve
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Whiting, Penny
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Harman, Kim
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Howe, Robin
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MacGowan, Alasdair
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Fletcher, Margaret
3b37c0d1-0d08-42e7-81d9-a58808662446
Hay, Alastair
e493ad13-cd46-4587-88f8-45f789fdb878

Butler, Christopher, Sterne, Jonathan, Lawton, Michael, OBrien, Kathryn, Wootten, Mandy, Hood, Kerenza, Holllingworth, William, Little, Paul, Delaney, Brendan, Van der Voort, Judith, Dudley, Jan, Birnie, Kate, PIckles, Timothy, Waldron, Cherry-Ann, Dowinng, Harriet, Emma, Thomas-Jones, Lisles, Catherine, Rumsby, Kate, Durbaba, Steve, Whiting, Penny, Harman, Kim, Howe, Robin, MacGowan, Alasdair, Fletcher, Margaret and Hay, Alastair (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. (doi:10.3399/bjgp16X685873). (PMID:27364678)

Record type: Article

Abstract

Background: although sampling urine using nappy pads is preferred by parents and recommended when a clean catch sample can’t be obtained, we do not know the added diagnostic utility of ‘nappy pad’ urine samples, nor the proportion that are contaminated.

Setting: acutely unwell children <5 years presenting to 233 primary care sites in England and Wales.

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 to findings from clean catch samples.

Results: nappy pad samples were obtained from 3205 children (82% <2 years; 48% female), and culture results available for 2277 (71.0%). 30 (1.3%) met our laboratory definition of UTI. Female gender, smelly urine, darker urine, and absence of nappy rash were independently associated with UTI, with an internally validated, coefficient model AUROC of 0.81 (0.87 for clean catch) that increased to 0.87 (0.90 for clean catch) with the addition of dipstick results. GPs’ ‘working diagnosis’ had an AUROC 0.63 (95% CI 0.53 to 0.72). 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 to clean catch urine culture results, which should be prioritised. Dipstick testing adds diagnostic accuracy.


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More information

Accepted/In Press date: 26 February 2016
e-pub ahead of print date: 30 June 2016
Published date: 1 July 2016
Keywords: antibacterial agents, diagnosis, infant, paediatrics, primary health care, urinary tract infections
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 399266
URI: https://eprints.soton.ac.uk/id/eprint/399266
ISSN: 0960-1643
PURE UUID: f7d997ad-3d5b-481e-a17c-0e889185efe5
ORCID for Kim Harman: ORCID iD orcid.org/0000-0002-5173-7753

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Date deposited: 11 Aug 2016 13:01
Last modified: 19 Jul 2019 19:49

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Contributors

Author: Christopher Butler
Author: Jonathan Sterne
Author: Michael Lawton
Author: Kathryn OBrien
Author: Mandy Wootten
Author: Kerenza Hood
Author: William Holllingworth
Author: Paul Little
Author: Brendan Delaney
Author: Judith Van der Voort
Author: Jan Dudley
Author: Kate Birnie
Author: Timothy PIckles
Author: Cherry-Ann Waldron
Author: Harriet Dowinng
Author: Thomas-Jones Emma
Author: Catherine Lisles
Author: Kate Rumsby
Author: Steve Durbaba
Author: Penny Whiting
Author: Kim Harman ORCID iD
Author: Robin Howe
Author: Alasdair MacGowan
Author: Margaret Fletcher
Author: Alastair Hay

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