The case against screening urinalyses for asymptomatic bacteriuria in children
K. J. Kemper and E. D. Avner
Department of Pediatrics, University of Washington, Seattle.
Screening children for asymptomatic bacteriuria to prevent pyelonephritis
and renal scarring is widely recommended, but its cost-effectiveness has
not been established. We reviewed published studies to determine the costs
and benefits of screening toilet-trained, asymptomatic children for
bacteriuria. Given the sensitivity and specificity of current screening
methods (approximately 80% each) and the prevalence of bacteriuria in
asymptomatic children (approximately 1% in girls and 0.03% in boys),
screening 100,000 children would result in 19,897 (20%) false-positive
tests; initial screening and two urine cultures to confirm the diagnosis of
asymptomatic bacteriuria would miss 28% of 515 children with true
bacteriuria, and cost nearly $2.9 million. There is no evidence that
detection and treatment of children with asymptomatic bacteriuria prevents
subsequent pyelonephritis or renal scarring. Screening for bacteriuria in
asymptomatic children is costly, fails to prevent pyelonephritis or renal
scarring, and should be discontinued as a part of routine well-child care.
