Researchers in Amsterdam offer a sophisticated analysis of different approaches to diagnosing acute uncomplicated urinary tract infections in women and propose a model that reduces the number of questions asked and urine investigations needed.
Analyzing data on 196 women presenting with painful and/or frequent micturition, researchers find that three questions, sometimes followed by a urine dipstick test, can provide a practical level of accuracy.
Specifically, they recommend asking:
- does the patient think she has a UTI
- is there at least considerable pain on micturition and
- 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 micturition 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, which avoids the possibility of a false-negative nitrite tests in patients with high UTI risk (greater than 70 percent) after history.
They assert that expensive and time-consuming urinary sediment and dipslide tests appear to add little diagnostic information. The authors call for future research to validate these recommendations.
Toward a Simple Diagnostic Index for Acute Uncomplicated Urinary Tract Infections
By Bart J. Knottnerus, et al
University of Amsterdam, The Netherlands