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Eur J Pediatr Surg 2025; 35(04): 269-276
DOI: 10.1055/a-2490-1156
Original Article

Utility of Urine Dipstick Testing in Pediatric Appendicitis: Assessing its Role in Identifying Complicated Cases and Retrocecal Appendicitis

Clara Månsson Biehl
1   Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden
,
Matilda Elliver
1   Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden
,
Johanna Gudjonsdottir 
1   Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden
2   Department of Surgery, Skåne University Hospital, Malmö, Skåne, Sweden
,
Martin Salö
1   Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden
3   Department of Pediatric Surgery, Skåne University Hospital, Lund, Skåne, Sweden
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Funding None.
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Abstract

Background Diagnosing appendicitis in children remains a challenge, and the role of urine dipstick is controversial. This study aimed to evaluate the association between abnormal urine dipstick results and appendicitis, particularly appendicitis severity and appendix position.

Methods A prospective cohort study was conducted from 2017 to 2021 at a tertiary hospital in Sweden. Children aged ≤ 15 years with suspected appendicitis were included. Logistic regression was used to assess associations between abnormal urine dipstick results and sex, age, peritonitis, body temperature, C-reactive protein, complicated appendicitis, and appendix position.

Results A total of 311 children with suspected appendicitis were included, with 193 (62%) diagnosed with appendicitis. Among these, 80 (41%) had complicated appendicitis. There was no difference in appendicitis rate between children with positive and normal urine dipstick results. Among children with appendicitis, 119 (62%) had positive urine dipstick results: 49% ketones, 29% erythrocytes, 23% protein, 19% leukocytes, and 2% nitrite. Multivariable analysis revealed that female sex (adjusted odds ratio: 2.41 [95% confidence interval, CI: 1.21–4.80], p = 0.013), retrocecal appendicitis (aOR: 2.39 [95% CI: 1.18–4.84], p = 0.015), and complicated appendicitis (aOR: 2.27 [1.01–5.13], p = 0.015) were significantly associated with abnormal urine dipstick results. Sensitivity and specificity of positive urine dipstick for complicated appendicitis was 56% (95% CI: 45–67%) and 64% (95% CI: 54–73%), respectively, with an area under the curve of 0.62 (95% CI: 0.54–0.70). Limitations in this study include potential unmeasured confounders such as hydration status and urinary tract infections.

Conclusion Abnormal urine dipstick results are common in children with appendicitis. Urine dipstick might help identify cases of complicated and retrocecal appendicitis.

Keywords

appendicitis - urine dipstick - complicated appendicitis - retrocecal appendicitis

Data Availability Statement

Data supporting the conclusions of this study will be made available by the corresponding author on reasonable request but may not be used by another part for research purposes.


Author Contributions

C.M.B. collected data, performed the statistical analyses, and drafted the manuscript. J.G. recruited patients and revised the statistical analyses and the manuscript. M.E. helped with the data collection and revised the statistical analyses and the manuscript. M.S. designed the study, supervised the statistical analysis and drafting of the manuscript, and revised the final manuscript.


Supplementary Material



Publication History

Received: 06 July 2024

Accepted: 24 November 2024

Article published online:
19 December 2024

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