Documentation of Negative Urine Dipstick Results
A negative urine dipstick should be documented by specifically noting that all parameters are negative, including leukocyte esterase, nitrite, blood, and protein. 1
Components to Document in a Negative Urine Dipstick
When documenting a negative urine dipstick result, include the following elements:
Specific parameters tested and their results:
- Leukocyte esterase: Negative
- Nitrite: Negative
- Blood: Negative
- Protein: Negative
- Glucose: Negative
- pH: [actual value]
- Specific gravity: [actual value]
Method of interpretation: Visual reading vs. automated reader 2
- Both methods show almost perfect agreement (κ = 0.88) for clinically relevant parameters (nitrite and leukocyte esterase)
- Visual interpretation is acceptable when automated readers are unavailable
Collection method: Clean catch, catheterization, or bag specimen 1
- This is important as collection method affects interpretation, particularly in pediatric patients
Clinical Significance of Negative Results
A negative dipstick result has important clinical implications:
High negative predictive value: Negative dipstick results have a negative predictive value of 96-99% for ruling out urinary tract infection 3, 4
Reduced need for microscopy: Microscopic examination is not necessary when dipstick results are negative, which can save considerable laboratory time (>25 hours/month) without compromising patient safety 4
Reduced need for culture: In most clinical scenarios, a negative dipstick (especially negative for both leukocyte esterase and nitrite) can reliably predict a negative urine culture 3
Pitfalls and Caveats
Be aware of these important considerations when documenting negative results:
False negatives can occur: About 10% of children with UTIs may have negative rapid diagnostic tests 1
Timing matters: Document when the test was performed relative to sample collection, as prolonged standing can affect results
Quality control: Note if the dipstick was within its expiration date and properly stored
Specific populations: In certain high-risk populations (e.g., immunocompromised patients, pregnant women), negative dipstick results should not exclude further testing if clinical suspicion remains high 1
Transient factors: Exercise, dehydration, or highly dilute urine can affect results and should be noted if relevant 1
Sample Documentation Format
For standardized documentation in the medical record, use this format:
Urine Dipstick (Date/Time): NEGATIVE
- Leukocyte esterase: Negative
- Nitrite: Negative
- Blood: Negative
- Protein: Negative
- Glucose: Negative
- pH: [value]
- Specific gravity: [value]
- Collection method: [method]
- Interpretation method: [visual/automated]This comprehensive documentation approach ensures clinical decisions based on negative dipstick results are well-supported and defensible, while providing sufficient information for other healthcare providers to understand the testing context.