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From the *Department of Obstetrics and Gynecology, Leicester Warwick Medical School, University of Leicester, Leicester, United Kingdom; Division of Reproduction and Child Health, Birmingham Women's Hospital, Birmingham, United Kingdom; and the Department of Fetal Medicine, Division of Reproduction and Child Health, Birmingham Women's Hospital, Birmingham, United Kingdom.
Address reprint requests to: Mark Kilby, Professor in Maternal and Fetal Medicine, Division of Reproductive and Child Health, Birmingham Women's Hospital, Edgbaston, Birmingham B15 2TG, United Kingdom; e-mail: m.d.kilby{at}bham.ac.uk.
OBJECTIVE: To estimate the accuracy of point-of-care dipstick urinalysis in predicting significant proteinuria in pregnancy.
DATA SOURCES: Literature from 1970 to February 2002 was identified via 1) general bibliographic databases, that is, MEDLINE and EMBASE, 2) Cochrane Library and relevant specialist register of the Cochrane Collaboration, and 3) checking the reference lists of known primary and review articles.
METHODS OF STUDY SELECTION: Studies were selected if the accuracy of dipstick urinalysis techniques in predicting total protein excretion was estimated compared with a reference standard (laboratory estimation of protein excretion). The tests included visually read color-change dipsticks and automated dipstick urinalysis. Study selection, quality assessment, and data abstraction were performed independently and in duplicate.
TABULATION, INTEGRATION, AND RESULTS: Data from selected studies were abstracted as 2 x 2 tables comparing the test result with the reference standard. Test accuracy was expressed as likelihood ratios. Summary likelihood ratios were generated as measures of diagnostic accuracy to determine posttest probabilities. The electronic search produced 1,543 citations. After independent review of published articles, a total of 34 articles was obtained for further scrutiny, and 7 studies were considered eligible for inclusion in the review. The 6 studies evaluating visual dipstick urinalysis produced a pooled positive likelihood ratio of 3.48 (95% confidence interval 1.66, 7.27) and a pooled negative likelihood ratio of 0.6 (95% confidence interval 0.45, 0.8) for predicting 300 mg/24-hour proteinuria at the 1+ or greater threshold.
CONCLUSION: The accuracy of dipstick urinalysis with a 1+ threshold in the prediction of significant proteinuria is poor and therefore of limited usefulness to the clinician. Accuracy may be improved at higher thresholds (greater than 1+ proteinuria), but available data are sparse and of poor methodological quality. Therefore, it is not possible to make meaningful inferences about accuracy at higher urine dipstick thresholds. There is an urgent need for research in this area of common obstetric practice.
This article has been cited by other articles:
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  L. C Chappell and A. H Shennan Assessment of proteinuria in pregnancy BMJ, May 3, 2008; 336(7651): 968 - 969. [Full Text] [PDF]
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 S. Walerstein Review: point of care dipstick urinalysis has low accuracy for detecting proteinuria in pregnancy Evid. Based Med., February 1, 2005; 10(1): 25 - 25. [Full Text] [PDF]
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