The Effectiveness of Dipstick Urinalysis in Point of Care Urine Infection Diagnostic Process Within the Elderly Population: A Systematic Review

Background Urinary Tract Infection (UTI) in the older population is increasingly prevalent with age, (Bebell 2019). Symptoms frequently atypical, with confusion often being justification for antibiotic treatment, leading to likely overuse of antibiotics. Current guidance is not supportive of dipsticks in diagnosis of UTI in the over 65’s however, no guidance on dipstick use to rule out UTI, (Gov.uk, 2025). The aim of this review was to assess the negative predictive value of dipstick testing in older people with a suspected UTI. Methods A search strategy was designed to identify relevant publications. Titles and abstracts were screened against inclusion and exclusion criteria, followed by full text review. Data were extracted based on the STARD checklist. Risk of Bias was carried out using the QUADAS-2 tool. Synthesis without meta-analysis guidelines were followed to create a formal narrative synthesis. Results Five studies were included, 8,201 participants, mean average age 76 years. Each study had a slightly different focus using algorithms, point of care testing (POCT), or just urine samples. Dipstick sensitivity varies from 46–97% and specificity between 21–97%. The mean PPV and NPV across the studies was as 61% and 82% respectively. Conclusion The NPV is significantly better than the PPV when using PoC urinary dipsticks however currently there remains a distinct lack of evidence to support this strategy in ruling out a UTI in the over 65 population. Further clinical research is recommended in this field.