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Abstract：
OBJECTIVE: Urinary tract infections (UTIs) are common, but overdiagnosed, in children with spina bifida. We sought to evaluate the diagnostic test characteristics of urinalysis (UA) findings for symptomatic UTI in children with spina bifida.
METHODS: Retrospective cross-sectional study using data from 2 centers from January 1, 2016, to December 31, 2021. Children with myelomeningocele aged <19 years who had paired UA (and microscopy, when available) and urine culture were included. The primary outcome was symptomatic UTI. We used generalized estimating equations to control for multiple encounters per child and calculated area under the receiver operating characteristics curve, sensitivity, and specificity for positive nitrites, pyuria (≥10 white blood cells/high-powered field), and leukocyte esterase (more than trace) for a symptomatic UTI.
RESULTS: We included 974 encounters from 319 unique children, of which 120 (12.3%) met our criteria for UTI. Pyuria had the highest sensitivity while nitrites were the most specific. Comparatively, nitrites were the least sensitive and pyuria was the least specific. When the cohort was limited to children with symptoms of a UTI, pyuria remained the most sensitive parameter, whereas nitrites remained the least sensitive. Nitrites continued to be the most specific, whereas pyuria was the least specific. Among all encounters, the overall area under the receiver operating characteristics curve for all components of the UA was lower in children who use clean intermittent catheterizations compared with all others.
CONCLUSIONS: Individual UA findings have moderate sensitivity (leukocyte esterase or pyuria) or specificity (nitrites) but overall poor diagnostic accuracy for symptomatic UTIs in children with spina bifida.
OBJECTIVE: Urinary tract infections (UTIs) are common, but overdiagnosed, in children with spina bifida. We sought to evaluate the diagnostic test characteristics of urinalysis (UA) findings for symptomatic UTI in children with spina bifida.
METHODS: Retrospective cross-sectional study using data from 2 centers from January 1, 2016, to December 31, 2021. Children with myelomeningocele aged <19 years who had paired UA (and microscopy, when available) and urine culture were included. The primary outcome was symptomatic UTI. We used generalized estimating equations to control for multiple encounters per child and calculated area under the receiver operating characteristics curve, sensitivity, and specificity for positive nitrites, pyuria (≥10 white blood cells/high-powered field), and leukocyte esterase (more than trace) for a symptomatic UTI.
RESULTS: We included 974 encounters from 319 unique children, of which 120 (12.3%) met our criteria for UTI. Pyuria had the highest sensitivity while nitrites were the most specific. Comparatively, nitrites were the least sensitive and pyuria was the least specific. When the cohort was limited to children with symptoms of a UTI, pyuria remained the most sensitive parameter, whereas nitrites remained the least sensitive. Nitrites continued to be the most specific, whereas pyuria was the least specific. Among all encounters, the overall area under the receiver operating characteristics curve for all components of the UA was lower in children who use clean intermittent catheterizations compared with all others.
CONCLUSIONS: Individual UA findings have moderate sensitivity (leukocyte esterase or pyuria) or specificity (nitrites) but overall poor diagnostic accuracy for symptomatic UTIs in children with spina bifida.
摘要：
■尿路感染（UTI）很常见，但过度诊断,患有脊柱裂的儿童。我们试图评估脊柱裂儿童有症状UTI的尿液分析（UA）结果的诊断测试特征。
■使用2016年1月1日至2021年12月31日2个中心的数据进行回顾性横断面研究。年龄<19岁且有配对UA的脊髓膜膨出儿童（和显微镜，可用时）和尿液培养。主要结果是有症状的UTI。我们使用广义估计方程来控制每个孩子的多次相遇，并计算出接收器工作特性曲线下的面积，灵敏度,和对正亚硝酸盐的特异性，脓尿（≥10个白细胞/高倍视野），和白细胞酯酶（超过痕量）为有症状的UTI。
■我们包括来自319个独特孩子的974次相遇，其中120人（12.3%）符合我们的UTI标准。脓尿的敏感性最高，而亚硝酸盐的敏感性最高。相对而言,亚硝酸盐最不敏感，脓尿最不特异。当队列仅限于有UTI症状的儿童时，脓尿仍然是最敏感的参数，而亚硝酸盐仍然最不敏感。亚硝酸盐仍然是最具体的，而脓尿症的特异性最低。在所有的相遇中，与所有其他患者相比,在使用清洁间歇性导尿的儿童中,UA所有组件的受试者工作特征曲线下的总面积较低.
■在脊柱裂患儿中，个别UA检查结果具有中等敏感性（白细胞酯酶或脓尿）或特异性（亚硝酸盐），但总体诊断准确性较差。
■尿路感染（UTI）很常见，但过度诊断,患有脊柱裂的儿童。我们试图评估脊柱裂儿童有症状UTI的尿液分析（UA）结果的诊断测试特征。
■使用2016年1月1日至2021年12月31日2个中心的数据进行回顾性横断面研究。年龄<19岁且有配对UA的脊髓膜膨出儿童（和显微镜，可用时）和尿液培养。主要结果是有症状的UTI。我们使用广义估计方程来控制每个孩子的多次相遇，并计算出接收器工作特性曲线下的面积，灵敏度,和对正亚硝酸盐的特异性，脓尿（≥10个白细胞/高倍视野），和白细胞酯酶（超过痕量）为有症状的UTI。
■我们包括来自319个独特孩子的974次相遇，其中120人（12.3%）符合我们的UTI标准。脓尿的敏感性最高，而亚硝酸盐的敏感性最高。相对而言,亚硝酸盐最不敏感，脓尿最不特异。当队列仅限于有UTI症状的儿童时，脓尿仍然是最敏感的参数，而亚硝酸盐仍然最不敏感。亚硝酸盐仍然是最具体的，而脓尿症的特异性最低。在所有的相遇中，与所有其他患者相比,在使用清洁间歇性导尿的儿童中,UA所有组件的受试者工作特征曲线下的总面积较低.
■在脊柱裂患儿中，个别UA检查结果具有中等敏感性（白细胞酯酶或脓尿）或特异性（亚硝酸盐），但总体诊断准确性较差。
