Rapid Cerebrospinal Fluid Dipstick Testing for Early Diagnosis of Acute Bacterial Meningitis in Children: A Prospective Observational Study in Nepal

Introduction Acute bacterial meningitis (ABM) is a life-threatening emergency requiring prompt diagnosis and treatment. In resource-limited settings, rapid and reliable diagnostic methods are essential. This study evaluates the diagnostic accuracy of a urinary reagent dipstick test applied to cerebrospinal fluid (CSF) samples in children suspected of having ABM. Methods A prospective observational study was conducted at Kanti Children's Hospital, Kathmandu, Nepal, from February 2019 to April 2021. Children aged between three months and 14 years undergoing lumbar puncture for suspected meningitis were included. CSF samples were tested using Combur-10 (Roche Diagnostics GmbH, Mannheim, Germany) urinary dipsticks for leukocytes and protein and compared to standard laboratory analyses. Diagnostic accuracy was measured using sensitivity, specificity, predictive values, and Cohen's kappa coefficient. Results Seventy-six children were enrolled, with a median age of 4.5 years, and 48 (63%) participants were males. Laboratory analysis identified ABM in 21 cases (28%) based on the World Health Organization (WHO) criteria for probable bacterial meningitis. Dipstick testing diagnosed 26 cases (34.2%). The dipstick demonstrated a sensitivity of 95% (95% CI: 78.4% - 99.3%) and a specificity of 89% (95% CI: 77.8% - 95.1%). The positive predictive value (PPV) was 77% (95% CI: 57.5% - 89.4%), the negative predictive value (NPV) was 98% (95% CI: 87.3% - 99.8%), and the overall diagnostic accuracy was 91% (95% CI: 81.2% - 96%). Agreement between dipstick and conventional methods was statistically significant (Cohen's kappa = 0.785, p = 0.001). Conclusions Rapid dipstick testing of CSF is a reliable, cost-effective tool for early ABM diagnosis in children. It is particularly useful in settings lacking advanced laboratory infrastructure.