TY - JOUR T1 - Nappy pad urine samples for investigation and treatment of UTI in young children: the ‘DUTY’ prospective diagnostic cohort study JF - British Journal of General Practice JO - Br J Gen Pract SP - e516 LP - e524 DO - 10.3399/bjgp16X685873 VL - 66 IS - 648 AU - Christopher C Butler AU - Jonathan AC Sterne AU - Michael Lawton AU - Kathryn O’Brien AU - Mandy Wootton AU - Kerenza Hood AU - William Hollingworth AU - Paul Little AU - Brendan C Delaney AU - Judith van der Voort AU - Jan Dudley AU - Kate Birnie AU - Timothy Pickles AU - Cherry-Ann Waldron AU - Harriet Downing AU - Emma Thomas-Jones AU - Catherine Lisles AU - Kate Rumsby AU - Stevo Durbaba AU - Penny Whiting AU - Kim Harman AU - Robin Howe AU - Alasdair MacGowan AU - Margaret Fletcher AU - Alastair D Hay Y1 - 2016/07/01 UR - http://bjgp.org/content/66/648/e516.abstract N2 - Background The added diagnostic utility of nappy pad urine samples and the proportion that are contaminated is unknown.Aim To develop a clinical prediction rule for the diagnosis of urinary tract infection (UTI) based on sampling using the nappy pad method.Design and setting Acutely unwell children <5 years presenting to 233 UK primary care sites.Method Logistic regression to identify independent associations of symptoms, signs, and urine dipstick test results with UTI; diagnostic utility quantified as area under the receiver operator curves (AUROC). Nappy pad rule characteristics, AUROC, and contamination, compared with findings from clean-catch samples.Results Nappy pad samples were obtained from 3205 children (82% aged <2 years; 48% female), culture results were available for 2277 (71.0%) and 30 (1.3%) had a UTI on culture. Female sex, smelly urine, darker urine, and the absence of nappy rash were independently associated with a UTI, with an internally-validated, coefficient model AUROC of 0.81 (0.87 for clean-catch), which increased to 0.87 (0.90 for clean-catch) with the addition of dipstick results. GPs’ ‘working diagnosis’ had an AUROC 0.63 (95% confidence intervals [CI] = 0.53 to 0.72). A total of 12.2% of nappy pad and 1.8% of clean-catch samples were ‘frankly contaminated’ (risk ratio 6.66; 95% CI = 4.95 to 8.96; P<0.001).Conclusion Nappy pad urine culture results, with features that can be reported by parents and dipstick tests, can be clinically useful, but are less accurate and more often contaminated compared with clean-catch urine culture. ER -