Diagnostic Accuracy of Clinical Features for Urinary Tract Infection (Summary Estimates)
| Clinical Feature | No. Studiesa | N | Summary Sensitivity, % (95% CI) | Summary Specificity, % (95% CI) | Summary LR+ (95% CI) | Summary LR− (95% CI) |
|---|---|---|---|---|---|---|
| Red Flags (LR+ ≥4) or Features (LR− <0.25) | ||||||
| Hematuria | 3 | 5,615 | 4 (2-8) | 99 (97-100) | 4.23 (1.71-10.44) | 0.97 (0.94-1.00) |
| Cloudy urine | 4 | 3,866 | 69 (30-92) | 85 (72-92) | 4.55 (3.73-5.56) | 0.36 (0.13-1.02) |
| Malodorous urine | 4 | 7,109 | 31 (12-59) | 93 (75-98) | 4.13 (2.27-7.49) | 0.75 (0.58-0.98) |
| No circumcision | 8 | 6,712 | 88 (52-98) | 52 (23-80) | 1.81 (1.15-2.87) | 0.24 (0.08-0.72) |
| Amber Signs (LR+ 2-4 or LR− 0.25-0.5) | ||||||
| Dysuria | 7 | 5,413 | 40 (19-66) | 88 (80-93) | 3.28 (2.22-4.86) | 0.68 (0.47-1.00) |
| Frequency | 4 | 5,668 | 36 (22-53) | 84 (74-90) | 2.21 (1.78-2.75) | 0.76 (0.65-0.90) |
| Bed wetting | 3 | 5,436 | 21 (12-32) | 92 (84-97) | 2.70 (1.46-4.99) | 0.86 (0.78-0.95) |
| Previous UTI | 7 | 7,546 | 15 (9-24) | 94 (88-97) | 2.31 (1.73-3.10) | 0.91 (0.86-0.96) |
| No source of infection | 4 | 20,964 | 84 (74-91) | 45 (18-75) | 1.53 (0.92-2.54) | 0.35 (0.22-0.55) |
| Signs With LR+ <2 or LR− >0.5 | ||||||
| Diarrhea | 7 | 24,640 | 20 (12-30) | 78 (73-83) | 0.91 (0.68-1.22) | 1.03 (0.96-1.10) |
| Vomiting | 7 | 10,505 | 27 (19-38) | 69 (61-76) | 0.89 (0.74-1.06) | 1.05 (1.00-1.12) |
| Abdominal pain | 6 | 5,397 | 29 (14-51) | 84 (64-94) | 1.86 (0.82-4.22) | 0.84 (0.67-1.07) |
| No cough | 4 | 20,946 | 81 (33-97) | 32 (7-76) | 1.19 (0.93-1.52) | 0.61 (0.34-1.07) |
| Irritability | 5 | 5,395 | 15 (4-48) | 85 (63-95) | 1.00 (0.67-1.48) | 1.00 (0.93-1.07) |
| Abnormal appearance | 4 | 26,525 | 36 (17-60) | 70 (50-85) | 1.21 (1.02-1.44) | 0.91 (0.80-1.04) |
| Age <12 mo | 3 | 2,110 | 67 (47-83) | 41 (28-55) | 1.13 (1.02-1.26) | 0.81 (0.61-1.07) |
| Female | 15 | 47,351 | 66 (57-74) | 47 (42-52) | 1.24 (1.11-1.39) | 0.73 (0.58-0.91) |
| White | 10 | 42,456 | 50 (34-65) | 58 (42-73) | 1.18 (0.96-1.46) | 0.87 (0.73-1.04) |
| Hispanic | 7 | 34,074 | 12 (4-32) | 89 (76-95) | 1.03 (0.74-1.44) | 1.00 (0.95-1.05) |
| Asian | 5 | 24,623 | 5 (4-7) | 96 (95-97) | 1.42 (1.09-1.86) | 0.98 (0.97-1.00) |
| Non-African American | 10 | 42,397 | 85 (76-91) | 27 (14-45) | 1.17 (1.02-1.33) | 0.55 (0.48-0.63) |
LR− = negative likelihood ratio; LR+ = positive likelihood ratio; UTI = urinary tract infection.
↵a Data from Pylkkänen et al38 were not included in the meta-analysis; bivariate random effects model by Chu and Cole.21