Abstract

Objective: This study aimed to assess the diagnostic accuracy of the urine dipstick test and urinalysis compared with urine culture in children presenting with suspected urinary tract infections (UTIs) in a tertiary emergency department.
Methods: This retrospective cohort study included children aged ≤14 years presenting to King Fahad Medical City’s pediatric emergency department between January 2023 and December 2024. The data included demo graphics, symptoms, urine collection methods, and laboratory results.
Results: Of the 276 patients, urine culture was positive in 23.9%. Leukocyte esterase and nitrite positivity were significantly associated with culture positivity (p < 0.001). Leukocyte esterase showed 52.9% sensitivity and 85.5% specificity, whereas nitrite showed 63.6% sensitivity and a 96.2% negative predictive value. Microscopic analysis of white blood cells and bacteria revealed high specificity (93.4% and 89.1%, respectively), but low sensitivity (31% and 28.7%, respectively). A change in urine smell was the only symptom significantly associated with a positive culture (p-value = 0.023).
Conclusion: The dipstick test and urinalysis offer valuable early diagnostic guidance, particularly for detecting nitrite and leukocyte esterase and ruling out UTIs; however, urine culture remains essential for a definitive diagnosis.

Key words: Pediatric urinary tract infection, urine dipstick, urine culture, diagnostic accuracy, Saudi Arabia