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Context: Maintaining precise ranges of urine pH and specific gravity (SG) is essential to avoid toxicity in patients receiving high-dose methotrexate (HDMTX) for acute lymphoblastic processes and osteosarcoma. Three urinalysis methods are used: manually read dipsticks (DpH/DSG), automated dipsticks (ApH/ASG), and urinalysis machines (UpH/USG). Objective: To compare the reliability of manual and automated dipsticks to urinalysis machines, as urinalysis machines are currently the most reliable and accurate method based on literature review. Design: Retrospective chart review comparing pH and SG measurements of patients who received HDMTX from January 2017 to June 2020. Setting: Southwest Cancer Center at University Medical Center (UMC) in Lubbock, TX (county hospital). Patients or Other Participants: Patients receiving HDMTX (≥ 500 mg/m2) who were tested by ≥ 2 methods during a 4-hour period. Seventeen patients (59% female, average age 9.2 years) met inclusion criteria, but only 11 (81% female, average age 9.7 years) had sufficient data for analysis. Interventions: The study did not involve therapeutic, clinical, or diagnostic interventions. Main Outcomes Measures: Primary outcome measures are pH and specific gravity as measured by manual dipstick, automated dipstick, and urinalysis machine. Outcomes parameters were analyzed by Pearson product-moment correlation and paired sample t-test. Results: Each pair of methods correlated for pH readings, but only ApH and UpH showed a significant, strong positive correlation (r = 0.65, p = 0.003). DSG and ASG had a strong positive correlation (r = 0.833, p = 0.167), while ASG and USG had a moderate negative correlation (r = -0.454, p = 0.067), but neither of these were significant. Paired sample t-test revealed ASG was higher than USG (α=0.011, p≤ 0.05). No other mean differences were significant. Conclusions: Manual and automated dipsticks are as reliable as urinalysis machines for testing pH, but automated dipsticks yield a higher SG, while ApH and UpH are highly correlated. However, our findings may not be clinically significant due to small sample size and missing data from chart review. Further study using a larger sample and prospective approach could help assess cost-effective alternatives to standard urinalysis. |
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