ArticleThe British journal of general practice : the journal of the Royal College of General Practitioners2016
Nappy pad urine samples for investigation and treatment of UTI in young children: the 'DUTY' prospective diagnostic cohort study.
Article in The British journal of general practice : the journal of the Royal College of General Practitioners, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed, 11 citations in OpenAlex.
- Feasibility of home-based urine collection in children under 5 years in the ORIGINS birth cohort study: mixed method protocol and sample completion results.BMC nutrition · 2025Article
- Clinician and parent views on urine collection in precontinent children in the UK: a qualitative interview study.BMJ open · 2024Article
- Urine collection methods and dipstick testing in non-toilet-trained children.Pediatric nephrology (Berlin, Germany) · 2021Review
- Urine sample collection from young pre-continent children: common methods and the new Quick-Wee technique.The British journal of general practice : the journal of the Royal College of General Practitioners · 2020Article
- Comparison of risk factors for, and prevalence of, antibiotic resistance in contaminating and pathogenic urinary Escherichia coli in children in primary care: prospective cohort study.The Journal of antimicrobial chemotherapy · 2018Article
- Improving the Diagnosis and Treatment of Urinary Tract Infection in Young Children in Primary Care: Results from the DUTY Prospective Diagnostic Cohort Study.Annals of family medicine · 2016Article
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Authors and funding
25 authors at 5 institutions in 1 country.
Funding
Abstract
backgroundThe added diagnostic utility of nappy pad urine samples and the proportion that are contaminated is unknown.
aimTo develop a clinical prediction rule for the diagnosis of urinary tract infection (UTI) based on sampling using the nappy pad method. DESIGN AND
settingAcutely unwell children <5 years presenting to 233 UK primary care sites.
methodLogistic 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.
resultsNappy 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).
conclusionNappy 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.
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