Does clinical examination aid in the diagnosis of urinary tract infections in women? A systematic review and meta-analysis
Open Access
- 10 October 2011
- journal article
- research article
- Published by Springer Science and Business Media LLC in BMC Family Practice
- Vol. 12 (1), 111
- https://doi.org/10.1186/1471-2296-12-111
Abstract
Clinicians should be aware of the diagnostic values of various symptoms, signs and antecedents. This information is particularly important in primary care settings, where sophisticated diagnostic approaches are not always feasible. The aim of the study is to determine the probability that various symptoms, signs, antecedents and tests predict urinary tract infection (UTI) in women. We conducted a systematic search of the MEDLINE and EMBASE databases to identify articles published in all languages through until December 2008. We particularly focused on studies that examined the diagnostic accuracy of at least one symptom, sign or patient antecedent related to the urinary tract. We included studies where urine culture, a gold standard, was preformed by primary care providers on female subjects aged at least 14 years. A meta-analysis of the likelihood ratio was performed to assess variables related to the urinary tract symptoms. Of the 1, 212 articles identified, 11 met the selection criteria. Dysuria, urgency, nocturia, sexual activity and urgency with dysuria were weak predictors of urinary tract infection, whereas increases in vaginal discharge and suprapubic pain were weak predictors of the absence of infection. Nitrites or leukocytes in the dipstick test are the only findings that clearly favored a diagnosis of UTI. Clinical findings do not aid in the diagnosis of UTI among women who present with urinary symptoms. Vaginal discharge is a weak indicator of the absence of infection. The urine dipstick test was the most reliable tool for detecting UTI.Keywords
This publication has 100 references indexed in Scilit:
- Predicting acute uncomplicated urinary tract infection in women: a systematic review of the diagnostic accuracy of symptoms and signsBMC Family Practice, 2010
- Optimizing the diagnostic work-up of acute uncomplicated urinary tract infectionsBMC Family Practice, 2008
- Urinary Tract InfectionsPrimary Care: Clinics in Office Practice, 2008
- Urinary tract infection in primary careBMJ, 2007
- Les infections urinaires de la femme en médecine générale: Résultats d’un observatoire réalisé auprès de 7916 patientesLa Presse Médicale, 2006
- Infections urinaires de la femme: Les médecins généralistes ne suivent qu'une partie des recommandationsLa Presse Médicale, 2006
- UROLOGIC DISEASES IN AMERICA PROJECT: TRENDS IN RESOURCE USE FOR URINARY TRACT INFECTIONS IN WOMENJournal of Urology, 2005
- Management of urinary tract infections in female general practice patientsFamily Practice, 2004
- Urinary Tract InfectionJournal of the American Academy of Nurse Practitioners, 2001
- Problems of Spectrum and Bias in Evaluating the Efficacy of Diagnostic TestsThe New England Journal of Medicine, 1978