Diagnostic value of symptoms and clean-voided urine specimen in childhood urinary tract infection.

In diagnosing urinary tract infection (UTI) the symptoms of 477 infants and children and the findings in their clean-voided urine specimens were evaluated. 322 patients were considered infected, when a bacterial culture of suprapubic aspirate was used as a diagnostic reference. No diagnosis was attempted on the basis of symptoms only. Numerous bacteria or greater than or equal to 200 leuc./mm3 in an uncentrifuged clean-voided urine specimen or greater than or equal to 10(5) bact./ml in quantitative bacterial culture were found in 59%, 42% and 81% of the infected symptomatic patients. The diagnostic accuracies of these indices were 88%, 94% and 95%, respectively. In asymptomatic patients the accuracies were considerably lower. Among these infected patients normal or equivocal isolated findings in the clean-voided urine specimens were frequently seen, and could not markedly be reduced by the various related factors, such as technique of urine collection, urine specific gravity or pH of urine. None of the above mentioned indices of the clean-voided urine specimens seems to be alone accurate and sensitive enough for diagnosing UTI, and therefore these should be used in combination. The advantage of immediately obtaining results supports the use of urine microscopy as a primary diagnostic method in symptomatic UTI of childhood in particular.