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Symptom- and urinalysis-based approach to diagnosing urinary tract infections in children with neuropathic bladders

Abstract

Background

Accurately diagnosing urinary tract infections (UTI) in children with neuropathic bladders can be difficult given the lack of specificity of both clinical symptoms and routine screening tests. We aimed to identify a priori unknown classes/groups of children with neuropathic bladder with respect to symptoms and UA results and examine their relationships with odds of UTI.

Methods

We used latent class analysis (LCA) to identify unobserved classes/groups of children with neuropathic bladder based on symptoms and urinalysis (UA) results, respectively. Demographic and clinical data were gathered by retrospective chart review of a cohort with neuropathic bladder. Symptoms and UA results were obtained by chart review of visits where urine culture was ordered.

Results

Around 193 patients were included in UA results analysis and 179 in symptom-based analysis. Two latent classes of patients were identified with respect to symptoms, labeled “pyelonephritis class” and “cystitis class,” and two, with respect to UA results, were labeled “positive UA class” and “negative UA class.” The pyelonephritis class had significantly higher odds of UTI compared to the asymptomatic class. While odds of UTI in cystitis class were higher than the asymptomatic class, this difference was not statistically significant. Positive UA class had significantly higher odds of UTI compared to negative UA class.

Conclusion

Two unobserved classes/groups exist in children with neuropathic bladder with respect to symptoms, corresponding to cystitis and pyelonephritis, and two classes of UA results that correspond with either a positive or negative UA. Our results suggest a differential approach to treatments may be considered.

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Correspondence to Catherine S. Forster.

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Forster, C.S., Wang, J. Symptom- and urinalysis-based approach to diagnosing urinary tract infections in children with neuropathic bladders. Pediatr Nephrol (2020) doi:10.1007/s00467-019-04448-8

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Keywords

  • Neuropathic bladder
  • UTI
  • Cystitis
  • Pyelonephritis
  • Pediatrics