The urine dipstick test useful to rule out infections. A meta-analysis of the accuracy.
The urine dipstick test useful to rule out infections. A meta-analysis of the accuracy.
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DOI：
10.1186/1471-2490-4-4
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发表时间：
2004-06-02
期刊：
影响因子：
2
通讯作者：
Bouter LM
中科院分区：
文献类型：
--
作者：
Devillé WL;Yzermans JC;van Duijn NP;Bezemer PD;van der Windt DA;Bouter LM
许多研究已经评估了试纸测试作为菌尿和尿路感染（UTI）快速检测器的准确性。缺乏对试纸准确度异质性的充分解释引发了持续的争论。本荟萃分析的目的是总结关于尿液试纸检测诊断准确性的现有证据，同时考虑各种预定义的潜在异质性来源。在Medline和Embase中检索1990年至1999年的文献，并通过参考文献跟踪。选定的出版物应关注菌尿或尿路感染的诊断，调查亚硝酸盐和/或白细胞酯酶试纸测试的使用，并提供经验数据。使用检查表评估方法学质量。共收录70篇出版物。亚硝酸盐的准确性在孕妇（诊断比值比= 165）和老年人（DOR = 108）中较高。老年人和家庭医学阳性预测值≥80%。在泌尿科患者的研究中，白细胞酯酶的准确性较高（DOR = 276）。家庭医学的敏感性最高（86%）。阴性预测值高，在这两个测试在所有患者组和设置，除了在家庭医学。两种测试结果的组合显示灵敏度的重要增加。在泌尿科患者（DOR = 52）、儿童（DOR = 46）和存在临床信息（DOR = 28）的研究中，准确性较高。在家庭医学中进行的研究敏感性最高（90%）。在所有其他情况下，阳性检测结果组合的预测值均较低。总体而言，这篇综述表明，如果亚硝酸盐和白细胞酯酶的结果均为阴性，单独的尿试纸测试似乎在所有人群中都是有用的，以排除感染的存在。在不同的患者群体中，两种检测组合的敏感性在68%至88%之间变化，但阳性检测结果必须得到确认。虽然阳性检测结果的组合在家庭实践中非常敏感，但单独使用试纸检测来判定感染的有用性仍然值得怀疑，即使在高的预检测概率下。
Many studies have evaluated the accuracy of dipstick tests as rapid detectors of bacteriuria and urinary tract infections (UTI). The lack of an adequate explanation for the heterogeneity of the dipstick accuracy stimulates an ongoing debate. The objective of the present meta-analysis was to summarise the available evidence on the diagnostic accuracy of the urine dipstick test, taking into account various pre-defined potential sources of heterogeneity. Literature from 1990 through 1999 was searched in Medline and Embase, and by reference tracking. Selected publications should be concerned with the diagnosis of bacteriuria or urinary tract infections, investigate the use of dipstick tests for nitrites and/or leukocyte esterase, and present empirical data. A checklist was used to assess methodological quality. 70 publications were included. Accuracy of nitrites was high in pregnant women (Diagnostic Odds Ratio = 165) and elderly people (DOR = 108). Positive predictive values were ≥80% in elderly and in family medicine. Accuracy of leukocyte-esterase was high in studies in urology patients (DOR = 276). Sensitivities were highest in family medicine (86%). Negative predictive values were high in both tests in all patient groups and settings, except for in family medicine. The combination of both test results showed an important increase in sensitivity. Accuracy was high in studies in urology patients (DOR = 52), in children (DOR = 46), and if clinical information was present (DOR = 28). Sensitivity was highest in studies carried out in family medicine (90%). Predictive values of combinations of positive test results were low in all other situations. Overall, this review demonstrates that the urine dipstick test alone seems to be useful in all populations to exclude the presence of infection if the results of both nitrites and leukocyte-esterase are negative. Sensitivities of the combination of both tests vary between 68 and 88% in different patient groups, but positive test results have to be confirmed. Although the combination of positive test results is very sensitive in family practice, the usefulness of the dipstick test alone to rule in infection remains doubtful, even with high pre-test probabilities.