Utility of dipstick urinalysis as a guide to management of adults with suspected infection or hematuria

Background. This study was done to determine whether emergency department (ED) patient management decisions made on the basis of dipstick urinalysis are altered when results of urine microscopy become available. Methods. The study population was a prospective random sample of adult ED patients who had urinalysis ordered for detection of possible urinary tract infection (UTI) or hematuria. Clinicians were given the result of the dipstick urinalysis and were asked to formulate a management plan. Urine microscopy of the same specimen was obtained later, and the clinicians were asked if management was changed after results were known. Results. Of 166 urinalyses, 118 (71%) were ordered for suspected UTI, 32 (19%) for suspected hematuria, and 16 (10%) for both. Of 134 urinalyses, 58 (43%) were positive for leukocyte esterase or nitrites, and 15 of 48 (31%) were positive for blood. Microscopy prompted a management change in only 9 of 166 patients. Six changes resulted in therapy for UTI, one resulted in withholding of therapy for UTI, and two resulted in cancellation of plans for diagnostic imaging. When urinalysis was done only to detect hematuria, none of the 32 patients had a management change after microscopy. Conclusion. Dipstick urinalysis for blood or UTI is a reliable diagnostic test in ED patients. In 94% of patients, subsequent findings on urine microscopy did not prompt a change in management. Microscopy added nothing to dipstick results when clinicians suspected conditions causing hematuria alone. Primary use of dipstick urinalysis, with microscopy in selected cases, would likely result in considerable cost and time saving without compromising patient care.