Utility of Urine Dipstick Testing in Pediatric Appendicitis : Assessing its Role in Identifying Complicated Cases and Retrocecal Appendicitis
(2024) In European Journal of Pediatric Surgery- Abstract
BACKGROUND: Diagnosing appendicitis in children remains a challenge, and the role of urine dipstick is controversial. This study aimed to evaluate the association between abnormal urine dipstick results and appendicitis, particularly appendicitis severity and appendix position.
METHODS: A prospective cohort study was conducted from 2017 to 2021 at a tertiary hospital in Sweden. Children aged ≤ 15 years with suspected appendicitis were included. Logistic regression was used to assess associations between abnormal urine dipstick results and sex, age, peritonitis, body temperature, C-reactive protein, complicated appendicitis, and appendix position.
RESULTS: A total of 311 children with suspected appendicitis were included,... (More)
BACKGROUND: Diagnosing appendicitis in children remains a challenge, and the role of urine dipstick is controversial. This study aimed to evaluate the association between abnormal urine dipstick results and appendicitis, particularly appendicitis severity and appendix position.
METHODS: A prospective cohort study was conducted from 2017 to 2021 at a tertiary hospital in Sweden. Children aged ≤ 15 years with suspected appendicitis were included. Logistic regression was used to assess associations between abnormal urine dipstick results and sex, age, peritonitis, body temperature, C-reactive protein, complicated appendicitis, and appendix position.
RESULTS: A total of 311 children with suspected appendicitis were included, with 193 (62%) diagnosed with appendicitis. Among these, 80 (41%) had complicated appendicitis. There was no difference in appendicitis rate between children with positive and normal urine dipstick results. Among children with appendicitis, 119 (62%) had positive urine dipstick results: 49% ketones, 29% erythrocytes, 23% protein, 19% leukocytes, and 2% nitrite. Multivariable analysis revealed that female sex (adjusted odds ratio: 2.41 [95% confidence interval, CI: 1.21-4.80], p = 0.013), retrocecal appendicitis (aOR: 2.39 [95% CI: 1.18-4.84], p = 0.015), and complicated appendicitis (aOR: 2.27 [1.01-5.13], p = 0.015) were significantly associated with abnormal urine dipstick results. Sensitivity and specificity of positive urine dipstick for complicated appendicitis was 56% (95% CI: 45-67%) and 64% (95% CI: 54-73%), respectively, with an area under the curve of 0.62 (95% CI: 0.54-0.70). Limitations in this study include potential unmeasured confounders such as hydration status and urinary tract infections.
CONCLUSION: Abnormal urine dipstick results are common in children with appendicitis. Urine dipstick might help identify cases of complicated and retrocecal appendicitis.
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- author
- Biehl, Clara Månsson ; Elliver, Matilda LU ; Gudjonsdottir, Johanna LU and Salö, Martin LU
- organization
- publishing date
- 2024-12-19
- type
- Contribution to journal
- publication status
- epub
- subject
- in
- European Journal of Pediatric Surgery
- publisher
- Georg Thieme Verlag
- external identifiers
-
- pmid:39701137
- scopus:85212828007
- ISSN
- 1439-359X
- DOI
- 10.1055/a-2490-1156
- language
- English
- LU publication?
- yes
- additional info
- Thieme. All rights reserved.
- id
- 9cefb365-df64-4f0b-b704-7ac9cc285125
- date added to LUP
- 2024-12-20 08:59:55
- date last changed
- 2025-07-11 17:47:24
@article{9cefb365-df64-4f0b-b704-7ac9cc285125,
abstract = {{<p>BACKGROUND: Diagnosing appendicitis in children remains a challenge, and the role of urine dipstick is controversial. This study aimed to evaluate the association between abnormal urine dipstick results and appendicitis, particularly appendicitis severity and appendix position.</p><p>METHODS: A prospective cohort study was conducted from 2017 to 2021 at a tertiary hospital in Sweden. Children aged ≤ 15 years with suspected appendicitis were included. Logistic regression was used to assess associations between abnormal urine dipstick results and sex, age, peritonitis, body temperature, C-reactive protein, complicated appendicitis, and appendix position.</p><p>RESULTS: A total of 311 children with suspected appendicitis were included, with 193 (62%) diagnosed with appendicitis. Among these, 80 (41%) had complicated appendicitis. There was no difference in appendicitis rate between children with positive and normal urine dipstick results. Among children with appendicitis, 119 (62%) had positive urine dipstick results: 49% ketones, 29% erythrocytes, 23% protein, 19% leukocytes, and 2% nitrite. Multivariable analysis revealed that female sex (adjusted odds ratio: 2.41 [95% confidence interval, CI: 1.21-4.80], p = 0.013), retrocecal appendicitis (aOR: 2.39 [95% CI: 1.18-4.84], p = 0.015), and complicated appendicitis (aOR: 2.27 [1.01-5.13], p = 0.015) were significantly associated with abnormal urine dipstick results. Sensitivity and specificity of positive urine dipstick for complicated appendicitis was 56% (95% CI: 45-67%) and 64% (95% CI: 54-73%), respectively, with an area under the curve of 0.62 (95% CI: 0.54-0.70). Limitations in this study include potential unmeasured confounders such as hydration status and urinary tract infections.</p><p>CONCLUSION: Abnormal urine dipstick results are common in children with appendicitis. Urine dipstick might help identify cases of complicated and retrocecal appendicitis.</p>}},
author = {{Biehl, Clara Månsson and Elliver, Matilda and Gudjonsdottir, Johanna and Salö, Martin}},
issn = {{1439-359X}},
language = {{eng}},
month = {{12}},
publisher = {{Georg Thieme Verlag}},
series = {{European Journal of Pediatric Surgery}},
title = {{Utility of Urine Dipstick Testing in Pediatric Appendicitis : Assessing its Role in Identifying Complicated Cases and Retrocecal Appendicitis}},
url = {{http://dx.doi.org/10.1055/a-2490-1156}},
doi = {{10.1055/a-2490-1156}},
year = {{2024}},
}