{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T11:19:10Z","timestamp":1794482350506,"version":"4.9.1"},"reference-count":18,"publisher":"American Academy of Pediatrics (AAP)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,12,1]]},"abstract":"<jats:sec>\n                  <jats:title\/>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>BACKGROUND<\/jats:title>\n                  <jats:p>The objective of this study was to compare the accuracy of available tests for pyuria, including newer automated tests, and to examine the implications of requiring them for the diagnosis of urinary tract infections (UTIs).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>We included children between 1 and 36 months of age undergoing bladder catheterization for suspected UTIs who presented to 1 of 3 pediatric centers. Using a positive urine culture result as the reference standard, we compared the sensitivity of 5 modalities for assessing pyuria at the cutoffs most often used clinically for detecting children with a positive culture result: leukocyte esterase on a dipstick, white blood cell (WBC) count on manual microscopy with and without using a hemocytometer, automated WBC enumeration using flow cytometry, and automated WBC enumeration using digital imaging with particle recognition.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>A total of 4188 children were included. Among febrile children, the sensitivity of the 2 most widely available modalities, the leukocyte esterase test and WBC enumeration using digital imaging, had sensitivity values of 84% (95% confidence interval, 0.80\u20130.87) and 75% (95% confidence interval, 0.66\u20130.83), respectively.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Our findings suggest that for febrile children &amp;lt;36 months of age undergoing bladder catheterization for suspected UTI, pyuria will be absent in \u223c20% of children who are eventually shown to have pure growth of a pathogen on a culture. This raises questions about the appropriateness of requiring pyuria for the diagnosis of UTIs.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1542\/peds.2024-066600","type":"journal-article","created":{"date-parts":[[2024,11,20]],"date-time":"2024-11-20T08:07:13Z","timestamp":1732090033000},"source":"Crossref","is-referenced-by-count":13,"title":["Accuracy of Screening Tests for the Diagnosis of Urinary Tract Infections in Young Children"],"prefix":"10.1542","volume":"154","author":[{"given":"Nader","family":"Shaikh","sequence":"first","affiliation":[{"name":"aDivision of General Academic Pediatrics, University of Pittsburgh School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth A.","family":"Campbell","sequence":"additional","affiliation":[{"name":"aDivision of General Academic Pediatrics, University of Pittsburgh School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Calise","family":"Curry","sequence":"additional","affiliation":[{"name":"bDivision of Hospital Medicine, University of Cincinnati College of Medicine, Cincinnati Children\u2019s Hospital, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caitlin","family":"Mickles","sequence":"additional","affiliation":[{"name":"aDivision of General Academic Pediatrics, University of Pittsburgh School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth B.","family":"Cole","sequence":"additional","affiliation":[{"name":"aDivision of General Academic Pediatrics, University of Pittsburgh School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Liu","sequence":"additional","affiliation":[{"name":"aDivision of General Academic Pediatrics, University of Pittsburgh School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew C.","family":"Lee","sequence":"additional","affiliation":[{"name":"aDivision of General Academic Pediatrics, University of Pittsburgh School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabella O.","family":"Conway","sequence":"additional","affiliation":[{"name":"aDivision of General Academic Pediatrics, University of Pittsburgh School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace D.","family":"Mueller","sequence":"additional","affiliation":[{"name":"aDivision of General Academic Pediatrics, University of Pittsburgh School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asumi","family":"Gibeau","sequence":"additional","affiliation":[{"name":"aDivision of General Academic Pediatrics, University of Pittsburgh School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick W.","family":"Brady","sequence":"additional","affiliation":[{"name":"bDivision of Hospital Medicine, University of Cincinnati College of Medicine, Cincinnati Children\u2019s Hospital, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayne","family":"Rasmussen","sequence":"additional","affiliation":[{"name":"cClinical Laboratory, Children\u2019s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Kohlhepp","sequence":"additional","affiliation":[{"name":"cClinical Laboratory, Children\u2019s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heba","family":"Qureini","sequence":"additional","affiliation":[{"name":"aDivision of General Academic Pediatrics, University of Pittsburgh School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marva","family":"Moxey-Mims","sequence":"additional","affiliation":[{"name":"dDivision of Nephrology, Department of Pediatrics, Children\u2019s National Hospital, The George Washington University School of Medicine, Washington, District of Columbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Whitney","family":"Williams","sequence":"additional","affiliation":[{"name":"dDivision of Nephrology, Department of Pediatrics, Children\u2019s National Hospital, The George Washington University School of Medicine, Washington, District of Columbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Davis-Rodriguez","sequence":"additional","affiliation":[{"name":"bDivision of Hospital Medicine, University of Cincinnati College of Medicine, Cincinnati Children\u2019s Hospital, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2024,11,20]]},"reference":[{"issue":"4","key":"2024121614364655200_B1","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1016\/S1473-3099(10)70031-1","article-title":"Absolute and relative accuracy of rapid urine tests for urinary tract infection in children: a meta-analysis","volume":"10","author":"Williams","year":"2010","journal-title":"Lancet Infect Dis"},{"issue":"2","key":"2024121614364655200_B2","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1017\/S1481803500009891","article-title":"Incorporation bias in studies of diagnostic tests: how to avoid being biased about bias","volume":"10","author":"Worster","year":"2008","journal-title":"CJEM"},{"issue":"4","key":"2024121614364655200_B3","doi-asserted-by":"crossref","first-page":"e2023061931","DOI":"10.1542\/peds.2023-061931","article-title":"Support for the use of a new cutoff to define a positive urine culture in young children","volume":"152","author":"Shaikh","year":"2023","journal-title":"Pediatrics"},{"issue":"4","key":"2024121614364655200_B4","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1016\/S0022-3476(05)83127-0","article-title":"Pyuria and bacteriuria in urine specimens obtained by catheter from young children with fever","volume":"124","author":"Hoberman","year":"1994","journal-title":"J Pediatr"},{"issue":"1","key":"2024121614364655200_B5","doi-asserted-by":"crossref","first-page":"e20160087","DOI":"10.1542\/peds.2016-0087","article-title":"Association between uropathogen and pyuria","volume":"138","author":"Shaikh","year":"2016","journal-title":"Pediatrics"},{"key":"2024121614364655200_B6","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.jpeds.2019.10.019","article-title":"Prevalence of asymptomatic bacteriuria in children: a meta-analysis","volume":"217","author":"Shaikh","year":"2020","journal-title":"J Pediatr"},{"issue":"1","key":"2024121614364655200_B7","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1542\/peds.27.1.17","article-title":"A comparative study of bacterial cultures and colony counts in paired specimens of urine obtained by catheter versus voiding from normal infants and infants with urinary tract infection","volume":"27","author":"Pryles","year":"1961","journal-title":"Pediatrics"},{"key":"2024121614364655200_B8","first-page":"983","article-title":"Comparative bacteriologic study of urine obtained from children by percutaneous suprapubic aspiration of the bladder and by catheter","volume":"24","author":"Pryles","year":"1959","journal-title":"Pediatrics"},{"issue":"6","key":"2024121614364655200_B9","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.1007\/s00467-020-04854-3","article-title":"Neutrophil gelatinase-associated lipocalin for urinary tract infection and pyelonephritis: a systematic review","volume":"36","author":"Shaikh","year":"2021","journal-title":"Pediatr Nephrol"},{"key":"2024121614364655200_B10","doi-asserted-by":"crossref","first-page":"1368583","DOI":"10.3389\/fped.2024.1368583","article-title":"Evaluation of diagnostic accuracy of urine neutrophil gelatinase-associated lipocalin in patients with symptoms of urinary tract infections: a meta-analysis","volume":"12","author":"Zhang","year":"2024","journal-title":"Front Pediatr"},{"key":"2024121614364655200_B11","doi-asserted-by":"crossref","first-page":"113394","DOI":"10.1016\/j.jpeds.2023.113394","article-title":"Accuracy of NGAL as a biomarker for urinary tract infection in young febrile children: an individual patient data meta-analysis","volume":"258","author":"Forster","year":"2023","journal-title":"J Pediatr"},{"issue":"9","key":"2024121614364655200_B12","doi-asserted-by":"crossref","first-page":"2134","DOI":"10.1111\/apa.17278","article-title":"Urinary tract infections in young infants with a normal urine dipstick","volume":"113","author":"Lasry","year":"2024","journal-title":"Acta Paediatr"},{"issue":"6","key":"2024121614364655200_B13","doi-asserted-by":"crossref","first-page":"e20171090","DOI":"10.1542\/peds.2017-1090","article-title":"Urinary neutrophil gelatinase-associated lipocalin for the diagnosis of urinary tract infections","volume":"140","author":"Lubell","year":"2017","journal-title":"Pediatrics"},{"issue":"11","key":"2024121614364655200_B14","doi-asserted-by":"crossref","first-page":"2079","DOI":"10.1007\/s00467-017-3709-1","article-title":"Urine neutrophil gelatinase-associated lipocalin and other biomarkers in infants with urinary tract infection and in febrile controls","volume":"32","author":"Valdimarsson","year":"2017","journal-title":"Pediatr Nephrol"},{"issue":"25","key":"2024121614364655200_B15","doi-asserted-by":"crossref","first-page":"2367","DOI":"10.1056\/NEJMoa1401811","article-title":"Antimicrobial prophylaxis for children with vesicoureteral reflux","volume":"370","author":"Hoberman","year":"2014","journal-title":"N Engl J Med"},{"issue":"1","key":"2024121614364655200_B16","doi-asserted-by":"crossref","first-page":"e13","DOI":"10.1542\/peds.2015-0409","article-title":"Risk factors for recurrent urinary tract infection and renal scarring","volume":"136","author":"Keren","year":"2015","journal-title":"Pediatrics"},{"issue":"8","key":"2024121614364655200_B17","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1001\/jamapediatrics.2023.1979","article-title":"Short-course therapy for urinary tract infections in children: the SCOUT randomized clinical trial","volume":"177","author":"Zaoutis","year":"2023","journal-title":"JAMA Pediatr"},{"issue":"6","key":"2024121614364655200_B18","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1001\/jamapediatrics.2018.0217","article-title":"Development and validation of a calculator for estimating the probability of urinary tract infection in young febrile children","volume":"172","author":"Shaikh","year":"2018","journal-title":"JAMA Pediatr"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2024-066600\/1750346\/peds.2024-066600.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2024-066600\/1750346\/peds.2024-066600.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,16]],"date-time":"2024-12-16T14:37:11Z","timestamp":1734359831000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/154\/6\/e2024066600\/199945\/Accuracy-of-Screening-Tests-for-the-Diagnosis-of"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,20]]},"references-count":18,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2024,11,20]]},"published-print":{"date-parts":[[2024,12,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2024-066600","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,20]]},"article-number":"e2024066600"}}