The accuracy of signs and symptoms in the presumptive diagnosis of urinary tract infections among adult females admitted at the MPI-MCM
- Author:
Marirose Aplasca De Los Reyes
;
Sangit L. Kasaju
;
Emelrose Tinoco
- Publication Type:Journal Article
- From:
Philippine Journal of Internal Medicine
2011;49(1):22-29
- CountryPhilippines
- Language:English
-
Abstract:
Background: Among adul t female population, the accuracy of s igns and symptoms of urinary tract infect ion (UTI) remain an elusive issue in terms of diagnosis and management. It is a common practice to treat UTI when faced with a sign or symptom even without the benefit of a routine urinalysis. Objective: To determine the predictive accuracy of signs and symptoms of acute uncomplicated urinary tract infection among adult females. Design: Retrospective study of female patients admitted at the MPI-Medical Center Muntinlupa from January 2008 to December 2008 Materials and Methods: An independent review of records were carried out among females seen in an in-patient or out-patient basis. All female patients ages 18 and above without co-morbidity were included. We excluded those with complicated UTI, with gross anatomic deformities and those with nephrolithiasis. Data collected include age, sex , urinalysis and urine culture and sensitivity only after the signs and symptoms were ex tracted to prevent verification bias . Documented signs and symptoms of urinary tract infection were extracted using a checklist. If the symptom was otherwise reported, this was interpreted as negative. Values for sensitivity, specificity, negative and predictive values were reported. Results: A total of 80 females, with a mean age of 48.6, mostly married (44%) met the inclusion criteria. No single sign or symptom was sensitive to screen for UTI. Sensitivity and specificity values were high if symptoms occurred in combinations; fever with dysuria (Sn=87.3%, Sp=78.3%), wi th f lank pain (Sn=77.3%, Sp=97.3%) ; hypogastric pain (Sn=88%, Sp=87.5%); hypogastric pain with chills (Sn=84.3%, Sp=80.2%); flank pain plus chills (Sn=80.1%, Sp=76.4%); costo-vertebral angle tenderness (Sn=85.4%, Sp=86.2%). No single sign or symptom predicted UTI. Microscopic hematuria and pyuria were independent predictors (median cut-off ?5/hpf) (OR=1.77, 95% CI. 1.2-8.7, p=.013, and OR=2.22, 95% CI 1.2-5.6, p=.004 respectively). Conclusion : In assessing UT I among females , a combinat ion of signs and symptoms yield higher diagnostic accuracy rates than when taken singly.
