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 a re altered when results of urine microscopy become available. Methods. The study population was a prospective random sample of adult ED p atients who had urinalysis ordered for detection of possible urinary tract infection (UTI) or hematuria. Clinicians were given the result of the dipst ick urinalysis and were asked to formulate a management plan. Urine microsc opy 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 (1 9%) 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%) w ere positive for blood. Microscopy prompted a management change in only 9 o f 166 patients. Six changes resulted in therapy for UTI, one resulted in wi thholding of therapy for UTI, and two resulted in cancellation of plans for diagnostic imaging. When urinalysis was done only to detect hematuria, non e of the 32 patients had a management change after microscopy. Conclusion. Dipstick urinalysis for blood or UTI is a reliable diagnostic t est in ED patients. In 94% of patients, subsequent findings on urine micros copy did not prompt a change in management. Microscopy added nothing to dip stick results when clinicians suspected conditions causing hematuria alone. Primary use of dipstick urinalysis, with microscopy in selected cases, wou ld likely result in considerable cost and time saving without compromising patient care.