The Article in Brief
Toward a Simple Diagnostic Index for Acute Uncomplicated Urinary Tract Infections
Bart J. Knottnerus , and colleagues
Background Sixty percent of all women experience at least one acute uncomplicated urinary tract infection (UTI) during their life. Various medical history questions and urine investigations can be used for UTI diagnosis. This study analyzes different approaches to diagnosing acute uncomplicated urinary tract infections in women and proposes a model that reduces the number of questions asked and urine investigations needed.
What This Study Found Analyzing data on 196 women presenting with painful and/or frequent urination, researchers find that 3 questions, sometimes followed by a urine dipstick test, can provide a practical level of accuracy. Specifically, they recommend asking (1) does the patient think she has a UTI, (2) is there at least considerable pain on urination and (3) is there vaginal irritation? Asking these questions, they find, may be sufficient to correctly classify more than one-half of women with painful and/or frequent urination as having UTI risk of either less than 30 percent or greater than 70 percent. Subsequent performance of nitrite and blood dipstick tests raises this proportion to 73 percent. The percentage rises to 83 percent if a urine dipstick is performed only for patients with a UTI risk between 30 percent and 70 percent after history and avoids the possibility of a false-negative nitrate tests in patients with high UTI risk (greater than 70 percent) after history.
Implications
- Expensive and time-consuming urinary sediment and dipslide tests may add little diagnostic information. The authors call for future research to validate these recommendations.