The Effectiveness of Dipstick Urinalysis in Point of Care Urine Infection Diagnostic Process Within the Elderly Population: A Systematic Review

The Effectiveness of Dipstick Urinalysis in Point of Care Urine Infection Diagnostic Process Within the Elderly Population: A Systematic Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review The Effectiveness of Dipstick Urinalysis in Point of Care Urine Infection Diagnostic Process Within the Elderly Population: A Systematic Review Emma Coleman-Jones, Phil Evans, James Mingham, Rachel Everett, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7478903/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Urinary Tract Infection (UTI) in the older population is increasingly prevalent with age, (Bebell 2019 ). Symptoms frequently atypical, with confusion often being justification for antibiotic treatment, leading to likely overuse of antibiotics. Current guidance is not supportive of dipsticks in diagnosis of UTI in the over 65’s however, no guidance on dipstick use to rule out UTI, (Gov.uk, 2025 ). The aim of this review was to assess the negative predictive value of dipstick testing in older people with a suspected UTI. Methods A search strategy was designed to identify relevant publications. Titles and abstracts were screened against inclusion and exclusion criteria, followed by full text review. Data were extracted based on the STARD checklist. Risk of Bias was carried out using the QUADAS-2 tool. Synthesis without meta-analysis guidelines were followed to create a formal narrative synthesis. Results Five studies were included, 8,201 participants, mean average age 76 years. Each study had a slightly different focus using algorithms, point of care testing (POCT), or just urine samples. Dipstick sensitivity varies from 46–97% and specificity between 21–97%. The mean PPV and NPV across the studies was as 61% and 82% respectively. Conclusion The NPV is significantly better than the PPV when using PoC urinary dipsticks however currently there remains a distinct lack of evidence to support this strategy in ruling out a UTI in the over 65 population. Further clinical research is recommended in this field. Community Negative predictive value Older person Frailty Urinary tract infection Figures Figure 1 Figure 2 Introduction Urinary Tract Infection (UTI) is one of the most frequent conditions in the community setting requiring intervention (NHS England, 2023). The prevalence of UTI increases with age and is associated with an increasing burden on individuals’ health. During the year 2022/23 of 147285 admissions to hospitals in England that had a primary diagnosis of a UTI, 55.9% were in the over 65 population and 20.9% were from the 80–84 years age group (NHS England, 2023). The European Association of Urology (2023) reports that up to 50% of women experience an acute UTI with incidences increasing in those aged 65–74 years. This continues to grow as age increases (Amed et al. 2018). In older people a UTI does not always present with classic symptoms such as dysuria, fever, cloudy or foul-smelling urine, or pain or discomfort on urination, and may instead present with behaviour changes such as confusion, delirium, reduction in mobility or increasing falls (Kaur and Kaur, 2020 ). In this population a new or worsening confusion can often lead to an empirical prescription of antibiotics, which does not represent good clinical practice or good antimicrobial stewardship and may also lead to a rise in antibiotic resistance (Bartoletti et al. 2016 ). Urinalysis has a long history, and since the 1950’s (Cyriac, Holden and Tullus 2016 ), dipsticks have been seen as a swift and convenient method to indicate the presence of a UTI through raised nitrites which are a byproduct of some bacteria found in UTI’s, Leukocyte esterase an enzyme released by white blood cells as a response to infection, and blood in the urine. Today, there is a greater caution in employing the dipsticks especially in the older person, secondary to concerns over false positive results. Urine dipsticks alone have been demonstrated as having poor positive predictive power for ruling in urine infection (Maina et al. 2023 ). NICE guidelines recommend not using dipsticks in individuals over 65 years of age because of the high rate of false positive results and asymptomatic bacteraemia. NICE does not currently comment on using dipsticks for their NPV to rule out a UTI. There is research being conducted on several novel point of care testing methods, but these are in the early stages or awaiting regulatory approval. However, all these strategies appear to be based on PPV, aiming to demonstrate infection and type of bacteria for the appropriate prescription of antibiotics and not regarding the NPV in demonstrating the absence of infection in the older person. Currently, NICE ( 2023 ) recommends not using dipsticks as a point of care for the early population (or routine use in primary or community care), due to long waiting times for point of care testing, and unreliability in dipstick results for proving UTI. The current gold standard method for diagnosis of urine tract infection (UTI) is a midstream urine sample, tested by a laboratory through microbiological culture. Mid-stream urine testing has significant drawbacks in clinical practice, secondary to sample management, logistics and time required for laboratory testing (NHS UHNM, 2024 ), leading to an unavoidable delay in the clinician receiving the results and thus a potential delay in clinical decision making. Laboratory test is also significantly more costly than using a dipstick. A urine chemistry, microscopy and culture in 2021 was costed as £55 without the transport cost to the lab or consumables (The Path Lab, 2021 ), whereas a urinalysis dipstick test is reported by the NHS supply chain as being less than 22 pence a test. There are many potential benefits of having a reliable PoC method to rule out urinary infection. By improving the quality and speed of clinical decision making there is likely to be a reduction in inappropriate antibiotic prescriptions., This results in better clinical care but also reduces medication costs and more importantly represents better antibiotic use and lowering the carbon footprint of services, and reducing healthcare costs (e.g., cost per test, medication reduction, follow-up clinical contacts). Additionally, there would likely be a medication cost reduction as a result of less unnecessary antibiotic prescriptions. This in turn will support the principals of antibiotic stewardship and work to reduce antibiotic resistance. The aim of this systematic review is to evaluate the effectiveness of dipstick urinalysis in the over 65 years population to ascertain if dipstick urinalysis could be utilised to support decision making in disproving UTI. Methods Search methods A protocol for this systematic review has been registered on Prospero (CRD42024538933). The search strategy was created to investigate the use of dipsticks in the diagnosis of UTI in the elderly population, this can be found in the supplementary information S3; and performed using the following databases EMBASE and MEDLINE via OVID, Web of Science via Thomson Reuters, the Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL complete via EBSCO. The search was carried out on 10th May 2024. All published peer-reviewed studies that address the research question were eligible if meeting the inclusion criteria, there were no limitations on dates. The inclusion criteria were participants over 65 years of age in the community, primary or secondary care setting. Exclusion criteria were papers where participants mean age was under 65 years, participants with any type of urinary catheter. Systematic reviews, case-reports, editorials, and abstracts with no subsequent peer reviewed full text paper were excluded. Data collection Searches were uploaded to Rayyan, and duplicates removed. Two independent reviewers EC-J and PE screened the titles and abstracts against the inclusion and exclusion criteria. The full text of all potential studies was retrieved and assessed for eligibility by two independent reviewers. Where there was a disagreement regarding inclusion, consensus was achieved through discussion, if the two authors could not resolve the disagreement, a third author arbitrated. Missing data was requested via email contact to authors for clarification. The record selection process was documented in a PRISMA flow diagram. Data were extracted using a piloted excel form based on the STARD checklist (Bossuyt et al. 2015 ) and a subsample of 50% of included papers were checked by a second author. Primary outcomes in this review were NPV and PPV, secondary outcomes were likelihood ratio (LR), sensitivity and specificity of dipsticks., in some of the cases this has been worked as the information has not been clearly identifiable from the full texts review. All worked data has been carried out via an online sensitivity and specificity calculator (Zaborowska, Szyk and Bowater 2024 ), this was chosen due to gaps in the published papers and the calculator provided the data from the published data as seen in supplementary table 1 (S1). Risk of bias Risk of Bias (RoB) assessments were conducted by two independent persons (PE, CW) in isolation to enable impartial results, any areas of indecision or conflicting decisions were subjected to discussion and consensus reached. Risk of Bias tools used was the QUADAS-2 as this was most suited to the research question (Harrison et al, 2017 ). The QUADAS-2 tool (Whiting et al, 2011 ), tool uses four key domains- patient selection; index test, reference standard and flow of patients through the study in order to help understand the quality of the primary data. The tool asks a series of structured questions regarding each paper, and the investigator scores each domain in terms of risk of bias and concerns regarding applicability. Each paper was independently reviewed and scored by two investigators. Scores were then compared, and where there were poor agreement papers were jointly reviewed, and consensus achieved. Data synthesis A formal narrative synthesis following the synthesis without meta-analysis (SWiM) guidelines has been performed due to the inability to complete a formal meta-analysis (Campbell et al. 2020 ), this is secondary to the lack of comparable data. Continuous data has been presented as means ± standard deviations or medians and interquartile ranges as appropriate. Female to male ratio has been reported as n (%). Effect measures are NPV and PPV. Results Description of Participant characteristics 5 studies were eligible for inclusion with a total of 8,201 participants spanning 12 years. Table 1 shows the included papers and participant demographics. Table 1 Demographics and study design Author & Year Sample size F:M Age (Range) Study design Diagnostic tools Disease prevalence Shahid, et al. 2019 395 F = 55% M = 45% 76 (15–100) Prospective Clinical Proforma MSU Dipstick NR den Heijer, et al. 2012 603 M = 100% 65 (18–97) National surveillance study Clinical Symptoms - algorithm Dipstick MSU - Culture NR Shimoni, et al. 2018 6901 F = 53% M = 47% 84 (SD 9) Retrospective Dipstick MSU - Culture NR Latour, et al. 2022 137 NR 65+ Prospective Dipstick CRP Symptoms MSU - Culture NR Couderta, et al . 2019 165 NR 89 (73–102) Observational prospective Dipstick Symptoms CRP ↑ Microscopic examination 40.60% The combined median age of participants is 76 years. Three studies had an identifiable female to male participant ratio of which one study was 100% male participants, the other two studies declared 53–55% female and 45–47% male participants which is representative of the UK population, (Office for National Statistics, 2023 ). Description of Study characteristics The studies have each focused on different questions, not all declared the specific dipstick brand they have used, and these studies occasionally use an accompanying algorithm, POCT CRP, urine samples and cultures this can be found in Table 1 . Table 2 shows the outcomes of the studies extracted from the individual papers including the positive and negative likelihood ratios, negatively & positive predictive values of dipsticks. Table 2 Study outcomes. Study LR+ LR- PPV NPV Prevalence of UTI Shahid, et al. 2019 4.6 0.3647 67.29 85.98 30.90% den Heijer, et al. 2012 2.49 0.36 83.17 58.62 66.40% Shimoni, et al. 2018 U/K U/K U/K U/K 100% Latour, et al. 2022 1.18 0.3 14.13 96 12.21% Couderta, et al . 2019 1.84 0.16 55.71 90.14 40.60% U/K = Unknown A list of excluded papers can be found in supplementary information Table S2 Outcomes Across the studies included in this review there is a variation in the reported dipstick the NPV 59–96% and the PPV variation 14–83% as shown in the Table 2 . The variation in sensitivity from 69–97% and specificity variation between 21–85% as shown in Table S1. Even though there is variability in the results and carrying out a mean average of the four papers with known data for a consensus gives a PPV and NPV as 55% and 83% respectively. Risk of bias There was generally low risk of bias found across the flow and timing and reference standard domains however patient selection was evenly divided between low and high risk and the index test was mainly unclear. In terms of applicability whilst the reference standard was uniformly low index test and patient selection demonstrated high concerns regarding applicability (Table 3 ). Discussion The diagnostic accuracy of dipsticks in diagnosing a UTI appears to be particularly poor with the PPV found to be between 14%-83% NPV is between 58%-96%; which is further likely to improve when paired with a clear history and the identification of the signs and symptoms of a UTI Although the study carried out by Shimoni et al, ( 2018 ), had a prevalence of 100% (due to the study being carried out on participants with a proven bacteraemia) the sensitivity of the dipsticks was only 96.6%, this review has been unable to work out the NPV for this study however, they support the use of dipsticks in older population that show negative do not require culture thereby reducing inappropriate antibiotic use but, dependent on several factors such as clinician behaviour or urinalysis methodology. Taking this in to account a robust governance would be recommended to reduce variability in clinician behaviour with a supporting standard operating protocol for the urinalysis methodology to enable reliability in the result and management of cases. Den Heijer et al, ( 2012 ), conclude that in the male population (≥ r 60yrs of age) a positive dipstick for nitrates would be effective in the ruling in UTI, and can be as effective as a General Practitioner taking a clinical history. Arguably this method is not as effective at disproving the presence of a UTI. Although, the author acknowledges the study was focused on proving a UTI and this may have skewed the NVP and application of urinalysis for this purpose. It is likely that the ruling in UTI with dipstick will be higher in the older population due to the higher likelihood of asymptomatic bacteraemia therefore this study would not necessarily support the reduction in antibiotic prescription and other benefits of using dipsticks when trying to prove a negative. There are already applications of point of care testing for blood test such as CRP and U&E, the study conducted by Latour et al ( 2022 ) also included the use of CRP as a diagnostic with a positive being > 5mg/l, this combine with the urinalysis gave a NPV of 96% which is the most supportive result in adopting urinalysis in the community and this could potentially be a suitable blend of near or POCT in tandem with good history taking to rule out UTI’s. Comparison to existing evidence The diagnosis and initial management of UTI’s is not only a challenge in the UK as shown in an audit carried out in Spain by Llor et al. ( 2010 ) which identified that GPs did not fully adhere to guidelines in place, with 96.4% of potential UTI’s prescribed an antibiotic, this paper was not included in the review as the focus was on GPs actions and the population was incorrect, however shows that current guidance is not fully adhered to. Joseph, ( 2020 ), discusses the usefulness of dipsticks in the diagnosis of a UTI and acknowledges that they are often used routinely as part of an admission process regardless as of clinical indication. Joseph states this approach cannot be relied on in the older population due to often atypical presentation without local symptoms and the complex nature of the older population with often comorbidities. This discussion does not support the use of dipstick to prove UTI but also does not comment of the utility of dipstick in disproving UTI in the older population. Mambatta et al, ( 2015 ) found that when diagnosing UTI through dipsticks both the nitrate and leukocyte esterase tests should not be reviewed in isolation. It is argued if they are reviewed in isolation, the dipstick potentially becomes unreliable therefore if a patient has symptoms but a negative dipstick the sample should be sent for culturing to ensure correct management. The focus again on this study is on the proving of a UTI and does not comment on the use of dipsticks to prove a negative but does support the use as a screening tool in primary care or outpatient settings. SIGN ( 2020 ) do not recommend the use of dipsticks in the diagnosis process for women over 65; however does advise that a culture is used to identify a bacteria prior to antibiotic provision. There is no comment on utility in male population or using dipsticks to prove a negative result. NHS England, ( 2024 ) also recommends against using dipsticks in the diagnosis of UTI in the over 65 population but does not comment on utility in disproving UTI. Although, a meta-analysis carried out by Devillé et al. ( 2004 ), supports the use of dipsticks in the disproving a UTI if the leukocytes-esterase and nitrates are negative. Additionally, the use of dipsticks is supported by Hertz, et.al ( 2015 ) when used to reduce the reflex culturing of urine in an emergency department. Strengths and weaknesses This review has a distinct weakness in that the evidence pulled in was limited purely based on the low body of evidence aimed at UTI diagnosis in the older persons. A further weakness to this review is the gaps in the reported data in the studies leading to the research team being required to utilise a calculator to generate the outcomes from available data. The strength of this review is based on the way the evidence was analysed including blinding the independent reviewers. This review has also been planned and conducted in accordance with the guidance of Shenkin et al, ( 2017 ). Implications to practice As not all areas will have POCT for CRP, the lone use of urinalysis to prove a negative could be beneficial to reduce diagnostic uncertainty in atypical presentations while potentially reducing over prescription of antibiotics. There is a potential to request a local policy change with the aim of conducting a urinalysis test at patient bedside to rule out a UTI if the test is negative and the history does not suggest clear urinary infection, however should the urinalysis returns positive it should be sent for culture with empirical antibiotics being prescribed only in cases where a positive urinalysis and symptomatic until culture can confirm sensitivity. This may reduce the amount of empirical antibiotics used, supporting good antimicrobial stewardship principals, reduce the carbon and financial footprint of healthcare as well as the limiting the collateral effects to individuals. Implications to further research This review shows that unfortunately, there is a limited body of evidence in disproving UTI in the older population within the community or primary care setting therefore this paper recommends adding to the current body of evidence through an active research study specifically investigating the reliability and of urinalysis in the older population in the primary/community care setting focusing on the negative predictions to rule out infection. This review also recommends including the use of POCT for CRP as an adjunct in the rule in or out of a UTI. Recommendations This systematic review recommends in cases of diagnosing UTI in the older person to conduct a complete history with physical examination, should there be nil symptoms complete MSU if clinical reasoning warrants however not to prescribe in cases of asymptomatic unless a proven MSU shows a sensitivity. This review also recommends further investigation in the older community-based population utilising point of care diagnostics to reduce the incidents of empirical antibiotic prescriptions. Conclusion This review identifies a lack of evidence in the older population within the community or primary care setting when it comes to the diagnosis process for UTI. This review and published evidence do not currently support standalone dipstick method in the diagnosis of UTI but there is opportunity to utilise in the reduction of empirical antibiotics while there is no current guidance on using dipsticks to disprove UTI. When blended with history taking and physical examination as this may support the reduction in empirical antibiotics and ensure symptomatic cases are dealt with swiftly. A future project which investigates dipstick efficacy alongside a MSU & culture if dipstick is positive to support targeted antibiotic prescription is required to provide further evidence and support potential guidance or policy changes. All data information can be shared following reasonable scientific requests from the main author. Declarations Conflict of interest None Funding None Author Contribution E.C-J and P.E wrote the main body of manuscript, completed the review of evidence and data extraction.J.M and R.E supported review of evidence and data extraction.R.E supported the writing of discussion.P.E and C.W carried out the risk of bias assessment.C.W supported whole project to the main research team through advice and guidance. Acknowledgements None Amendment to Protocol The initial exclusion criteria included not in a hospital setting however this narrowed the potential data set too far and left potential appropriate studies out of the review pool, the amendment was updated on Prospero. References Ahmed H, Farewell D, Jones HM et al. Incidence and antibiotic prescribing for clinically diagnosed urinary tract infection in older adults in UK primary care, 2004-2014. PloS One 2018; 13 :e0190521. Bartoletti R, Cai T, Wagenlehner FM et al. Treatment of Urinary Tract Infections and Antibiotic Stewardship. European Urology Supplements 2016; 15 :81–7. Bebell L. Antibiotic-resistant urinary tract infections are on the rise. Harvard Health Blog 2019. Bossuyt PM, Reitsma JB, Bruns DE et al. STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies. BMJ 2015; 351 :h5527. Campbell M, McKenzie JE, Sowden A et al. 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Management of Suspected Bacterial Lower Urinary Tract Infection in Adult Women a National Clinical Guideline ., 2020. Whiting PF, Rutjes AWS, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, Leeflang MM, Sterne JAC, and Bossuyt PMM. QUADAS-2: A Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies. Ann Intern Med 155 (8):529-536, 2011. The Path Lab. The Path Lab Price List and User Guide ., 2021. Zaborowska Ł, Szyk B, Bowater J. Sensitivity And Specificity Calculator. wwwomnicalculatorcom 2024. Table Table 3 is available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files SupplementaryInformationContents.docx Table3.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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02:20:20","extension":"html","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":127760,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7478903/v1/92b0f0cd4cfbf16ba0ce244c.html"},{"id":93539647,"identity":"78529d9b-921e-4320-b39d-17fe37c644f2","added_by":"auto","created_at":"2025-10-15 02:20:19","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":34852,"visible":true,"origin":"","legend":"\u003cp\u003eStudy flow diagram.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7478903/v1/a44a298c931907990180f30d.png"},{"id":93541153,"identity":"e4bf1e60-a288-4c39-bafa-884fef7cd35d","added_by":"auto","created_at":"2025-10-15 02:28:19","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":85630,"visible":true,"origin":"","legend":"\u003cp\u003eRisk of Bias.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7478903/v1/3e9a7cb48db2fd4df5168d5f.png"},{"id":94645650,"identity":"27c92dee-2ed1-4aae-bb74-9ee4d30f8db0","added_by":"auto","created_at":"2025-10-29 08:39:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":802688,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7478903/v1/60a7533b-4cba-4e47-9bc7-84cda4a516ba.pdf"},{"id":93539650,"identity":"79a9686b-fdda-4f1f-a479-012699c2b4b9","added_by":"auto","created_at":"2025-10-15 02:20:19","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":143600,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryInformationContents.docx","url":"https://assets-eu.researchsquare.com/files/rs-7478903/v1/66246bc5ca889f524409336d.docx"},{"id":93539648,"identity":"0c88c268-1ee6-4ca2-9de1-e88bb079452a","added_by":"auto","created_at":"2025-10-15 02:20:19","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":41825,"visible":true,"origin":"","legend":"","description":"","filename":"Table3.docx","url":"https://assets-eu.researchsquare.com/files/rs-7478903/v1/4c5ebed4c4b4e382e7feec9b.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Effectiveness of Dipstick Urinalysis in Point of Care Urine Infection Diagnostic Process Within the Elderly Population: A Systematic Review","fulltext":[{"header":"Introduction","content":"\u003cp\u003eUrinary Tract Infection (UTI) is one of the most frequent conditions in the community setting requiring intervention (NHS England, 2023). The prevalence of UTI increases with age and is associated with an increasing burden on individuals\u0026rsquo; health. During the year 2022/23 of 147285 admissions to hospitals in England that had a primary diagnosis of a UTI, 55.9% were in the over 65 population and 20.9% were from the 80\u0026ndash;84 years age group (NHS England, 2023). The European Association of Urology (2023) reports that up to 50% of women experience an acute UTI with incidences increasing in those aged 65\u0026ndash;74 years. This continues to grow as age increases (Amed et al. 2018).\u003c/p\u003e\u003cp\u003eIn older people a UTI does not always present with classic symptoms such as dysuria, fever, cloudy or foul-smelling urine, or pain or discomfort on urination, and may instead present with behaviour changes such as confusion, delirium, reduction in mobility or increasing falls (Kaur and Kaur, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). In this population a new or worsening confusion can often lead to an empirical prescription of antibiotics, which does not represent good clinical practice or good antimicrobial stewardship and may also lead to a rise in antibiotic resistance (Bartoletti et al. \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eUrinalysis has a long history, and since the 1950\u0026rsquo;s (Cyriac, Holden and Tullus \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2016\u003c/span\u003e),\u003c/p\u003e\u003cp\u003edipsticks have been seen as a swift and convenient method to indicate the presence of a UTI through raised nitrites which are a byproduct of some bacteria found in UTI\u0026rsquo;s, Leukocyte esterase an enzyme released by white blood cells as a response to infection, and blood in the urine. Today, there is a greater caution in employing the dipsticks especially in the older person, secondary to concerns over false positive results.\u003c/p\u003e\u003cp\u003eUrine dipsticks alone have been demonstrated as having poor positive predictive power for ruling in urine infection (Maina et al. \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). NICE guidelines recommend not using dipsticks in individuals over 65 years of age because of the high rate of false positive results and asymptomatic bacteraemia. NICE does not currently comment on using dipsticks for their NPV to rule out a UTI.\u003c/p\u003e\u003cp\u003eThere is research being conducted on several novel point of care testing methods, but these are in the early stages or awaiting regulatory approval. However, all these strategies appear to be based on PPV, aiming to demonstrate infection and type of bacteria for the appropriate prescription of antibiotics and not regarding the NPV in demonstrating the absence of infection in the older person. Currently, NICE (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) recommends not using dipsticks as a point of care for the early population (or routine use in primary or community care), due to long waiting times for point of care testing, and unreliability in dipstick results for proving UTI.\u003c/p\u003e\u003cp\u003eThe current gold standard method for diagnosis of urine tract infection (UTI) is a midstream urine sample, tested by a laboratory through microbiological culture.\u003c/p\u003e\u003cp\u003eMid-stream urine testing has significant drawbacks in clinical practice, secondary to sample management, logistics and time required for laboratory testing (NHS UHNM, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), leading to an unavoidable delay in the clinician receiving the results and thus a potential delay in clinical decision making.\u003c/p\u003e\u003cp\u003eLaboratory test is also significantly more costly than using a dipstick. A urine chemistry, microscopy and culture in 2021 was costed as \u0026pound;55 without the transport cost to the lab or consumables (The Path Lab, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), whereas a urinalysis dipstick test is reported by the NHS supply chain as being less than 22 pence a test.\u003c/p\u003e\u003cp\u003eThere are many potential benefits of having a reliable PoC method to rule out urinary infection. By improving the quality and speed of clinical decision making there is likely to be a reduction in inappropriate antibiotic prescriptions., This results in better clinical care but also reduces medication costs and more importantly represents better antibiotic use and lowering the carbon footprint of services, and reducing healthcare costs (e.g., cost per test, medication reduction, follow-up clinical contacts). Additionally, there would likely be a medication cost reduction as a result of less unnecessary antibiotic prescriptions. This in turn will support the principals of antibiotic stewardship and work to reduce antibiotic resistance.\u003c/p\u003e\u003cp\u003eThe aim of this systematic review is to evaluate the effectiveness of dipstick urinalysis in the over 65 years population to ascertain if dipstick urinalysis could be utilised to support decision making in disproving UTI.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eSearch methods\u003c/h2\u003e\u003cp\u003eA protocol for this systematic review has been registered on Prospero (CRD42024538933). The search strategy was created to investigate the use of dipsticks in the diagnosis of UTI in the elderly population, this can be found in the supplementary information S3; and performed using the following databases EMBASE and MEDLINE via OVID, Web of Science via Thomson Reuters, the Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL complete via EBSCO. The search was carried out on 10th May 2024.\u003c/p\u003e\u003cp\u003eAll published peer-reviewed studies that address the research question were eligible if meeting the inclusion criteria, there were no limitations on dates. The inclusion criteria were participants over 65 years of age in the community, primary or secondary care setting. Exclusion criteria were papers where participants mean age was under 65 years, participants with any type of urinary catheter.\u003c/p\u003e\u003cp\u003eSystematic reviews, case-reports, editorials, and abstracts with no subsequent peer reviewed full text paper were excluded.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eSearches were uploaded to Rayyan, and duplicates removed. Two independent reviewers EC-J and PE screened the titles and abstracts against the inclusion and exclusion criteria. The full text of all potential studies was retrieved and assessed for eligibility by two independent reviewers. Where there was a disagreement regarding inclusion, consensus was achieved through discussion, if the two authors could not resolve the disagreement, a third author arbitrated. Missing data was requested via email contact to authors for clarification. The record selection process was documented in a PRISMA flow diagram.\u003c/p\u003e\u003cp\u003eData were extracted using a piloted excel form based on the STARD checklist (Bossuyt et al. \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) and a subsample of 50% of included papers were checked by a second author. Primary outcomes in this review were NPV and PPV, secondary outcomes were likelihood ratio (LR), sensitivity and specificity of dipsticks., in some of the cases this has been worked as the information has not been clearly identifiable from the full texts review. All worked data has been carried out via an online sensitivity and specificity calculator (Zaborowska, Szyk and Bowater \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), this was chosen due to gaps in the published papers and the calculator provided the data from the published data as seen in supplementary table 1 (S1).\u003c/p\u003e\n\u003ch3\u003eRisk of bias\u003c/h3\u003e\n\u003cp\u003eRisk of Bias (RoB) assessments were conducted by two independent persons (PE, CW) in isolation to enable impartial results, any areas of indecision or conflicting decisions were subjected to discussion and consensus reached. Risk of Bias tools used was the QUADAS-2 as this was most suited to the research question (Harrison et al, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). The QUADAS-2 tool (Whiting et al, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2011\u003c/span\u003e), tool uses four key domains- patient selection; index test, reference standard and flow of patients through the study in order to help understand the quality of the primary data. The tool asks a series of structured questions regarding each paper, and the investigator scores each domain in terms of risk of bias and concerns regarding applicability. Each paper was independently reviewed and scored by two investigators. Scores were then compared, and where there were poor agreement papers were jointly reviewed, and consensus achieved.\u003c/p\u003e\n\u003ch3\u003eData synthesis\u003c/h3\u003e\n\u003cp\u003e A formal narrative synthesis following the synthesis without meta-analysis (SWiM) guidelines has been performed due to the inability to complete a formal meta-analysis (Campbell et al. \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), this is secondary to the lack of comparable data. Continuous data has been presented as means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations or medians and interquartile ranges as appropriate. Female to male ratio has been reported as n (%). Effect measures are NPV and PPV.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eDescription of Participant characteristics\u003c/h2\u003e\u003cp\u003e5 studies were eligible for inclusion with a total of 8,201 participants spanning 12 years. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the included papers and participant demographics.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographics and study design\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAuthor \u0026amp; Year\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSample size\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF:M\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAge (Range)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eStudy design\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDiagnostic tools\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eDisease prevalence\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eShahid, et al. \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2019\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e395\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;55%\u003c/p\u003e\u003cp\u003eM\u0026thinsp;=\u0026thinsp;45%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e76\u003c/p\u003e\u003cp\u003e(15\u0026ndash;100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eProspective\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eClinical\u003c/p\u003e\u003cp\u003eProforma\u003c/p\u003e\u003cp\u003eMSU\u003c/p\u003e\u003cp\u003eDipstick\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNR\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eden Heijer, et al. \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2012\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e603\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eM\u0026thinsp;=\u0026thinsp;100%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e65\u003c/p\u003e\u003cp\u003e(18\u0026ndash;97)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNational surveillance study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eClinical Symptoms - algorithm \u003c/p\u003e\u003cp\u003eDipstick\u003c/p\u003e\u003cp\u003eMSU - Culture\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNR\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eShimoni, et al. \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2018\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6901\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;53%\u003c/p\u003e\u003cp\u003eM\u0026thinsp;=\u0026thinsp;47%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e84\u003c/p\u003e\u003cp\u003e(SD 9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRetrospective\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDipstick\u003c/p\u003e\u003cp\u003eMSU - Culture\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNR\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLatour, et al. \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2022\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e137\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e65+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eProspective\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDipstick\u003c/p\u003e\u003cp\u003eCRP\u003c/p\u003e\u003cp\u003eSymptoms\u003c/p\u003e\u003cp\u003eMSU - Culture\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNR\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCouderta, \u003cem\u003eet al\u003c/em\u003e. 2019\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e165\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e89\u003c/p\u003e\u003cp\u003e(73\u0026ndash;102)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eObservational prospective\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDipstick\u003c/p\u003e\u003cp\u003eSymptoms\u003c/p\u003e\u003cp\u003eCRP \u0026uarr;\u003c/p\u003e\u003cp\u003eMicroscopic examination\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e40.60%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe combined median age of participants is 76 years. Three studies had an identifiable female to male participant ratio of which one study was 100% male participants, the other two studies declared 53\u0026ndash;55% female and 45\u0026ndash;47% male participants which is representative of the UK population, (Office for National Statistics, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eDescription of Study characteristics\u003c/h3\u003e\n\u003cp\u003eThe studies have each focused on different questions, not all declared the specific dipstick brand they have used, and these studies occasionally use an accompanying algorithm, POCT CRP, urine samples and cultures this can be found in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the outcomes of the studies extracted from the individual papers including the positive and negative likelihood ratios, negatively \u0026amp; positive predictive values of dipsticks.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eStudy outcomes.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStudy\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLR+\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLR-\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePPV\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNPV\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePrevalence of UTI\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eShahid, et al. \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2019\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.3647\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e67.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e85.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e30.90%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eden Heijer, et al. \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2012\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e83.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e58.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e66.40%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eShimoni, et al. \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2018\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eU/K\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eU/K\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eU/K\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eU/K\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLatour, et al. \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2022\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e12.21%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCouderta, \u003cem\u003eet al\u003c/em\u003e. 2019\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e55.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e90.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e40.60%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cem\u003eU/K\u0026thinsp;=\u0026thinsp;Unknown\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eA list of excluded papers can be found in supplementary information Table S2\u003c/p\u003e\n\u003ch3\u003eOutcomes\u003c/h3\u003e\n\u003cp\u003eAcross the studies included in this review there is a variation in the reported dipstick the NPV 59\u0026ndash;96% and the PPV variation 14\u0026ndash;83% as shown in the Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003eThe variation in sensitivity from 69\u0026ndash;97% and specificity variation between 21\u0026ndash;85% as shown in Table S1. Even though there is variability in the results and carrying out a mean average of the four papers with known data for a consensus gives a PPV and NPV as 55% and 83% respectively.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eRisk of bias\u003c/h2\u003e\u003cp\u003eThere was generally low risk of bias found across the flow and timing and reference standard domains however patient selection was evenly divided between low and high risk and the index test was mainly unclear. In terms of applicability whilst the reference standard was uniformly low index test and patient selection demonstrated high concerns regarding applicability (Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe diagnostic accuracy of dipsticks in diagnosing a UTI appears to be particularly poor with the PPV found to be between 14%-83% NPV is between 58%-96%; which is further likely to improve when paired with a clear history and the identification of the signs and symptoms of a UTI\u003c/p\u003e\u003cp\u003eAlthough the study carried out by Shimoni et al, (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), had a prevalence of 100% (due to the study being carried out on participants with a proven bacteraemia) the sensitivity of the dipsticks was only 96.6%, this review has been unable to work out the NPV for this study however, they support the use of dipsticks in older population that show negative do not require culture thereby reducing inappropriate antibiotic use but, dependent on several factors such as clinician behaviour or urinalysis methodology. Taking this in to account a robust governance would be recommended to reduce variability in clinician behaviour with a supporting standard operating protocol for the urinalysis methodology to enable reliability in the result and management of cases.\u003c/p\u003e\u003cp\u003eDen Heijer et al, (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2012\u003c/span\u003e), conclude that in the male population (\u0026ge;\u0026thinsp;r 60yrs of age) a positive dipstick for nitrates would be effective in the ruling in UTI, and can be as effective as a General Practitioner taking a clinical history. Arguably this method is not as effective at disproving the presence of a UTI. Although, the author acknowledges the study was focused on proving a UTI and this may have skewed the NVP and application of urinalysis for this purpose. It is likely that the ruling in UTI with dipstick will be higher in the older population due to the higher likelihood of asymptomatic bacteraemia therefore this study would not necessarily support the reduction in antibiotic prescription and other benefits of using dipsticks when trying to prove a negative.\u003c/p\u003e\u003cp\u003eThere are already applications of point of care testing for blood test such as CRP and U\u0026amp;E, the study conducted by Latour et al (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) also included the use of CRP as a diagnostic with a positive being \u0026gt;\u0026thinsp;5mg/l, this combine with the urinalysis gave a NPV of 96% which is the most supportive result in adopting urinalysis in the community and this could potentially be a suitable blend of near or POCT in tandem with good history taking to rule out UTI\u0026rsquo;s.\u003c/p\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eComparison to existing evidence\u003c/h2\u003e\u003cp\u003eThe diagnosis and initial management of UTI\u0026rsquo;s is not only a challenge in the UK as shown in an audit carried out in Spain by Llor et al. (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2010\u003c/span\u003e) which identified that GPs did not fully adhere to guidelines in place, with 96.4% of potential UTI\u0026rsquo;s prescribed an antibiotic, this paper was not included in the review as the focus was on GPs actions and the population was incorrect, however shows that current guidance is not fully adhered to.\u003c/p\u003e\u003cp\u003eJoseph, (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), discusses the usefulness of dipsticks in the diagnosis of a UTI and acknowledges that they are often used routinely as part of an admission process regardless as of clinical indication. Joseph states this approach cannot be relied on in the older population due to often atypical presentation without local symptoms and the complex nature of the older population with often comorbidities. This discussion does not support the use of dipstick to prove UTI but also does not comment of the utility of dipstick in disproving UTI in the older population.\u003c/p\u003e\u003cp\u003eMambatta et al, (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) found that when diagnosing UTI through dipsticks both the nitrate and leukocyte esterase tests should not be reviewed in isolation. It is argued if they are reviewed in isolation, the dipstick potentially becomes unreliable therefore if a patient has symptoms but a negative dipstick the sample should be sent for culturing to ensure correct management. The focus again on this study is on the proving of a UTI and does not comment on the use of dipsticks to prove a negative but does support the use as a screening tool in primary care or outpatient settings.\u003c/p\u003e\u003cp\u003eSIGN (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) do not recommend the use of dipsticks in the diagnosis process for women over 65; however does advise that a culture is used to identify a bacteria prior to antibiotic provision. There is no comment on utility in male population or using dipsticks to prove a negative result.\u003c/p\u003e\u003cp\u003eNHS England, (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) also recommends against using dipsticks in the diagnosis of UTI in the over 65 population but does not comment on utility in disproving UTI. Although, a meta-analysis carried out by Devill\u0026eacute; et al. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2004\u003c/span\u003e), supports the use of dipsticks in the disproving a UTI if the leukocytes-esterase and nitrates are negative. Additionally, the use of dipsticks is supported by Hertz, et.al (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) when used to reduce the reflex culturing of urine in an emergency department.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eStrengths and weaknesses\u003c/h2\u003e\u003cp\u003eThis review has a distinct weakness in that the evidence pulled in was limited purely based on the low body of evidence aimed at UTI diagnosis in the older persons. A further weakness to this review is the gaps in the reported data in the studies leading to the research team being required to utilise a calculator to generate the outcomes from available data.\u003c/p\u003e\u003cp\u003eThe strength of this review is based on the way the evidence was analysed including blinding the independent reviewers. This review has also been planned and conducted in accordance with the guidance of Shenkin et al, (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eImplications to practice\u003c/h2\u003e\u003cp\u003eAs not all areas will have POCT for CRP, the lone use of urinalysis to prove a negative could be beneficial to reduce diagnostic uncertainty in atypical presentations while potentially reducing over prescription of antibiotics.\u003c/p\u003e\u003cp\u003eThere is a potential to request a local policy change with the aim of conducting a urinalysis test at patient bedside to rule out a UTI if the test is negative and the history does not suggest clear urinary infection, however should the urinalysis returns positive it should be sent for culture with empirical antibiotics being prescribed only in cases where a positive urinalysis and symptomatic until culture can confirm sensitivity.\u003c/p\u003e\u003cp\u003eThis may reduce the amount of empirical antibiotics used, supporting good antimicrobial stewardship principals, reduce the carbon and financial footprint of healthcare as well as the limiting the collateral effects to individuals.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eImplications to further research\u003c/h2\u003e\u003cp\u003eThis review shows that unfortunately, there is a limited body of evidence in disproving UTI in the older population within the community or primary care setting therefore this paper recommends adding to the current body of evidence through an active research study specifically investigating the reliability and of urinalysis in the older population in the primary/community care setting focusing on the negative predictions to rule out infection. This review also recommends including the use of POCT for CRP as an adjunct in the rule in or out of a UTI.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eRecommendations\u003c/h2\u003e\u003cp\u003eThis systematic review recommends in cases of diagnosing UTI in the older person to conduct a complete history with physical examination, should there be nil symptoms complete MSU if clinical reasoning warrants however not to prescribe in cases of asymptomatic unless a proven MSU shows a sensitivity. This review also recommends further investigation in the older community-based population utilising point of care diagnostics to reduce the incidents of empirical antibiotic prescriptions.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis review identifies a lack of evidence in the older population within the community or primary care setting when it comes to the diagnosis process for UTI. This review and published evidence do not currently support standalone dipstick method in the diagnosis of UTI but there is opportunity to utilise in the reduction of empirical antibiotics while there is no current guidance on using dipsticks to disprove UTI. When blended with history taking and physical examination as this may support the reduction in empirical antibiotics and ensure symptomatic cases are dealt with swiftly. A future project which investigates dipstick efficacy alongside a MSU \u0026amp; culture if dipstick is positive to support targeted antibiotic prescription is required to provide further evidence and support potential guidance or policy changes.\u003c/p\u003e\u003cp\u003eAll data information can be shared following reasonable scientific requests from the main author.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eConflict of interest\u003c/h2\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eE.C-J and P.E wrote the main body of manuscript, completed the review of evidence and data extraction.J.M and R.E supported review of evidence and data extraction.R.E supported the writing of discussion.P.E and C.W carried out the risk of bias assessment.C.W supported whole project to the main research team through advice and guidance.\u003c/p\u003e\n\u003ch2\u003eAcknowledgements\u003c/h2\u003e\n\u003cp\u003eNone\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eAmendment to Protocol\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe initial exclusion criteria included not in a hospital setting however this narrowed the potential data set too far and left potential appropriate studies out of the review pool, the amendment was updated on Prospero.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAhmed H, Farewell D, Jones HM \u003cem\u003eet al.\u003c/em\u003e Incidence and antibiotic prescribing for clinically diagnosed urinary tract infection in older adults in UK primary care, 2004-2014. \u003cem\u003ePloS One\u003c/em\u003e 2018;\u003cstrong\u003e13\u003c/strong\u003e:e0190521.\u003c/li\u003e\n\u003cli\u003eBartoletti R, Cai T, Wagenlehner FM \u003cem\u003eet al.\u003c/em\u003e Treatment of Urinary Tract Infections and Antibiotic Stewardship. \u003cem\u003eEuropean Urology Supplements\u003c/em\u003e 2016;\u003cstrong\u003e15\u003c/strong\u003e:81\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eBebell L. Antibiotic-resistant urinary tract infections are on the rise. \u003cem\u003eHarvard Health Blog\u003c/em\u003e 2019.\u003c/li\u003e\n\u003cli\u003eBossuyt PM, Reitsma JB, Bruns DE \u003cem\u003eet al.\u003c/em\u003e STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies. \u003cem\u003eBMJ\u003c/em\u003e 2015;\u003cstrong\u003e351\u003c/strong\u003e:h5527.\u003c/li\u003e\n\u003cli\u003eCampbell M, McKenzie JE, Sowden A \u003cem\u003eet al.\u003c/em\u003e Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline. \u003cem\u003eBMJ\u003c/em\u003e 2020;\u003cstrong\u003e368\u003c/strong\u003e, DOI: https://doi.org/10.1136/bmj.l6890.\u003c/li\u003e\n\u003cli\u003eCoudert M, P\u0026eacute;pin M, de Thezy A \u003cem\u003eet al.\u003c/em\u003e Pr\u0026eacute;sentation clinique et performance de la bandelette urinaire pour le diagnostic d\u0026rsquo;infection urinaire en population g\u0026eacute;riatrique. \u003cem\u003eLa Revue de M\u0026eacute;decine Interne\u003c/em\u003e 2019;\u003cstrong\u003e40\u003c/strong\u003e:714\u0026ndash;21.\u003c/li\u003e\n\u003cli\u003eCyriac J, Holden K, Tullus K. How to use\u0026hellip; urine dipsticks. \u003cem\u003eArchives of disease in childhood - Education \u0026amp; practice edition\u003c/em\u003e 2016;\u003cstrong\u003e102\u003c/strong\u003e:148\u0026ndash;54.\u003c/li\u003e\n\u003cli\u003eden Heijer CD, van Dongen MC, Donker GA \u003cem\u003eet al.\u003c/em\u003e Diagnostic approach to urinary tract infections in male general practice patients: a national surveillance study. \u003cem\u003eThe British Journal of General Practice\u003c/em\u003e 2012;\u003cstrong\u003e62\u003c/strong\u003e:e780\u0026ndash;6.\u003c/li\u003e\n\u003cli\u003eDevill\u0026eacute; WL, Yzermans JC, van Duijn NP \u003cem\u003eet al.\u003c/em\u003e The urine dipstick test useful to rule out infections. A meta-analysis of the accuracy. \u003cem\u003eBMC Urology\u003c/em\u003e 2004;\u003cstrong\u003e4\u003c/strong\u003e, DOI: https://doi.org/10.1186/1471-2490-4-4.\u003c/li\u003e\n\u003cli\u003eEAU. INTRODUCTION - Uroweb. \u003cem\u003eUroweb - European Association of Urology\u003c/em\u003e 2023.\u003c/li\u003e\n\u003cli\u003eGov.uk. Diagnosis of urinary tract infections: quick reference tools for primary care. \u003cem\u003eGOVUK\u003c/em\u003e 2025.\u003c/li\u003e\n\u003cli\u003eHarrison JK, Reid J, Quinn TJ \u003cem\u003eet al.\u003c/em\u003e Using Quality Assessment Tools to Critically Appraise Ageing research: a Guide for Clinicians. \u003cem\u003eAge and Ageing\u003c/em\u003e 2017;\u003cstrong\u003e46\u003c/strong\u003e:359\u0026ndash;65.\u003c/li\u003e\n\u003cli\u003eHertz JT, Lescallette RD, Barrett TW \u003cem\u003eet al.\u003c/em\u003e External validation of an ED protocol for reflex urine culture cancelation. \u003cem\u003eThe American Journal of Emergency Medicine\u003c/em\u003e 2015;\u003cstrong\u003e33\u003c/strong\u003e:1838\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eJoseph A. The Diagnosis and Management of UTI in \u0026gt;65s: To Dipstick or Not? The Argument Against Dipsticks. \u003cem\u003eInfection Prevention in Practice\u003c/em\u003e 2020;\u003cstrong\u003e2\u003c/strong\u003e:100063.\u003c/li\u003e\n\u003cli\u003eKaur R, Kaur R. Symptoms, risk factors, diagnosis and treatment of urinary tract infections. \u003cem\u003ePostgraduate Medical Journal\u003c/em\u003e 2020;\u003cstrong\u003e97\u003c/strong\u003e:postgradmedj-2020-139090.\u003c/li\u003e\n\u003cli\u003eLatour K, De Lepeleire J, Catry B \u003cem\u003eet al.\u003c/em\u003e Nursing home residents with suspected urinary tract infections: a diagnostic accuracy study. \u003cem\u003eBMC Geriatrics\u003c/em\u003e 2022;\u003cstrong\u003e22\u003c/strong\u003e, DOI: https://doi.org/10.1186/s12877-022-02866-2.\u003c/li\u003e\n\u003cli\u003eLlor C, Rabanaque G, Lopez A \u003cem\u003eet al.\u003c/em\u003e The adherence of GPs to guidelines for the diagnosis and treatment of lower urinary tract infections in women is poor. \u003cem\u003eFamily Practice\u003c/em\u003e 2010;\u003cstrong\u003e28\u003c/strong\u003e:294\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eMaina J, Mwaniki J, Mwiti F \u003cem\u003eet al.\u003c/em\u003e Evaluation of the diagnostic performance of the urine dipstick test for the detection of urinary tract infections in patients treated in Kenyan hospitals. \u003cem\u003eAccess Microbiology\u003c/em\u003e 2023;\u003cstrong\u003e5\u003c/strong\u003e, DOI: https://doi.org/10.1099/acmi.0.000483.v3.\u003c/li\u003e\n\u003cli\u003eMambatta A, Rashme V, Menon S \u003cem\u003eet al.\u003c/em\u003e Reliability of dipstick assay in predicting urinary tract infection. \u003cem\u003eJournal of Family Medicine and Primary Care\u003c/em\u003e 2015;\u003cstrong\u003e4\u003c/strong\u003e:265.NHS England. NHS England\u0026raquo; New awareness campaign to help reduce hospital admissions for urinary tract infections. \u003cem\u003ewwwenglandnhsuk\u003c/em\u003e 2023.\u003c/li\u003e\n\u003cli\u003eNICE. Overview | Point-of-care tests for urinary tract infections to improve antimicrobial prescribing: early value assessment | Guidance | NICE. \u003cem\u003ewwwniceorguk\u003c/em\u003e 2023.\u003c/li\u003e\n\u003cli\u003eNHS England. Diagnosis of urinary tract infections: quick reference tools for primary care. \u003cem\u003eGOVUK\u003c/em\u003e 2024.\u003c/li\u003e\n\u003cli\u003eNHS UHNM. Urine Culture and Sensitivity | University Hospitals of North Midlands. \u003cem\u003eUniversity Hospitals of North Midlands\u003c/em\u003e 2024.\u003c/li\u003e\n\u003cli\u003eOffice for National Statistics. Male and female populations. \u003cem\u003ewwwethnicity-facts-figuresservicegovuk\u003c/em\u003e 2023.\u003c/li\u003e\n\u003cli\u003ePublic Health England. \u003cem\u003eUK Standards for Microbiology Investigations Investigation of Urine\u003c/em\u003e., 2019.\u003c/li\u003e\n\u003cli\u003eShahid K, Yassar Alamri, Scowcroft H \u003cem\u003eet al.\u003c/em\u003e Urinalysis orders and yield among General Medicine patients: a single-centre\u0026rsquo;s experience in New Zealand. \u003cem\u003eThe New Zealand Medical Journal\u003c/em\u003e 2019;\u003cstrong\u003e132\u003c/strong\u003e:21\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eShenkin SD, Harrison JK, Wilkinson T \u003cem\u003eet al.\u003c/em\u003e Systematic reviews: guidance relevant for studies of older people. \u003cem\u003eAge and Ageing\u003c/em\u003e 2017;\u003cstrong\u003e46\u003c/strong\u003e:722\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eShimoni Z, Hermush V, Glick J \u003cem\u003eet al.\u003c/em\u003e No need for a urine culture in elderly hospitalized patients with a negative dipstick test result. \u003cem\u003eEuropean Journal of Clinical Microbiology \u0026amp; Infectious Diseases\u003c/em\u003e 2018;\u003cstrong\u003e37\u003c/strong\u003e:1459\u0026ndash;64.\u003c/li\u003e\n\u003cli\u003eSIGN. \u003cem\u003eManagement of Suspected Bacterial Lower Urinary Tract Infection in Adult Women a National Clinical Guideline\u003c/em\u003e., 2020.\u003c/li\u003e\n\u003cli\u003eWhiting PF, Rutjes AWS, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, Leeflang MM, Sterne JAC, and Bossuyt PMM. QUADAS-2: A Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies. Ann Intern Med 155 (8):529-536, 2011.\u003c/li\u003e\n\u003cli\u003eThe Path Lab. \u003cem\u003eThe Path Lab Price List and User Guide\u003c/em\u003e., 2021.\u003c/li\u003e\n\u003cli\u003eZaborowska Ł, Szyk B, Bowater J. Sensitivity And Specificity Calculator. \u003cem\u003ewwwomnicalculatorcom\u003c/em\u003e 2024.\u003cbr\u003e \u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table","content":"\u003cp\u003eTable 3 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Community, Negative predictive value, Older person, Frailty, Urinary tract infection","lastPublishedDoi":"10.21203/rs.3.rs-7478903/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7478903/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eUrinary Tract Infection (UTI) in the older population is increasingly prevalent with age, (Bebell \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Symptoms frequently atypical, with confusion often being justification for antibiotic treatment, leading to likely overuse of antibiotics. Current guidance is not supportive of dipsticks in diagnosis of UTI in the over 65\u0026rsquo;s however, no guidance on dipstick use to rule out UTI, (Gov.uk, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). The aim of this review was to assess the negative predictive value of dipstick testing in older people with a suspected UTI.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA search strategy was designed to identify relevant publications. Titles and abstracts were screened against inclusion and exclusion criteria, followed by full text review. Data were extracted based on the STARD checklist. Risk of Bias was carried out using the QUADAS-2 tool. Synthesis without meta-analysis guidelines were followed to create a formal narrative synthesis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eFive studies were included, 8,201 participants, mean average age 76 years. Each study had a slightly different focus using algorithms, point of care testing (POCT), or just urine samples. Dipstick sensitivity varies from 46\u0026ndash;97% and specificity between 21\u0026ndash;97%. The mean PPV and NPV across the studies was as 61% and 82% respectively.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe NPV is significantly better than the PPV when using PoC urinary dipsticks however currently there remains a distinct lack of evidence to support this strategy in ruling out a UTI in the over 65 population. Further clinical research is recommended in this field.\u003c/p\u003e","manuscriptTitle":"The Effectiveness of Dipstick Urinalysis in Point of Care Urine Infection Diagnostic Process Within the Elderly Population: A Systematic Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-15 02:20:15","doi":"10.21203/rs.3.rs-7478903/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8aab3251-35fc-4a69-8cb1-87336ce5d3e4","owner":[],"postedDate":"October 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-29T08:38:49+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-15 02:20:15","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7478903","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7478903","identity":"rs-7478903","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}