Abstract
Patients presenting with symptoms suggestive of urinary tract infection were recruited in a general practice survey aimed at measuring the predictive value of symptoms, history and urine dipstick testing for diagnosing the presence of bacterial infection. Urine specimens were obtained from 87% of the 521 patients recruited. A diagnosis of infection was established by urine culture producing a colony count in a pure culture exceeding 100 000 organisms per ml or between 10 000 and 100 000 organisms per ml plus a minimum of 100 leucocytes per mm3.
Occurrence rates for symptoms and other items of information in infected and non-infected groups were used to derive their positive and negative predictive values in making the diagnosis. The predictive value of volunteered symptoms was compared with that of elicited and volunteered symptoms combined. The positive predictive value of symptoms was increased where elicited symptoms were included but this was achieved at the cost of diminishing the negative predictive value. The occurrence rates were used to derive a mathematical model for diagnosing infection. The symptoms-history-urinalysis (SHU) score generated in this model compared well with a computer predicted probability. Both were substantially better than the assessment and action (decision to prescribe an antibiotic) of the recording doctor.
The scoring method described has been demonstrated in urinary tract infection but may be applied to any symptom combination related to a diagnosis for which there is an agreed definition.
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Selected References
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- Brooks D., Maudar A. Pathogenesis of the urethral syndrome in women and its diagnosis in general practice. Lancet. 1972 Oct 28;2(7783):893–898. doi: 10.1016/s0140-6736(72)92532-9. [DOI] [PubMed] [Google Scholar]
- GALLAGHER D. J., MONTGOMERIE J. Z., NORTH J. D. ACUTE INFECTIONS OF THE URINARY TRACT AND THE URETHRAL SYNDROME IN GENERAL PRACTICE. Br Med J. 1965 Mar 6;1(5435):622–626. doi: 10.1136/bmj.1.5435.622. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hamilton-Miller J. M., Brumfitt W., Brooks S. J., Bakhtiar M. Screening for bacteriuria: Microstix and dipslides. Postgrad Med J. 1977 May;53(619):248–250. doi: 10.1136/pgmj.53.619.248. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Horrocks J. C., McCann A. P., Staniland J. R., Leaper D. J., De Dombal F. T. Computer-aided diagnosis: description of an adaptable system, and operational experience with 2,034 cases. Br Med J. 1972 Apr 1;2(5804):5–9. doi: 10.1136/bmj.2.5804.5. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Jordan S., Wilcox G. M., Wasson J. H. Urinary tract infection in women visiting rural primary care practices. J Fam Pract. 1982 Sep;15(3):427–429. [PubMed] [Google Scholar]
- Murphy D. M., Cafferkey M. T., Falkiner F. R., Gillespie W. A., Nelson H. G., Ruddock G. Urinary tract infection in female patients -a survey in general practice in the Dublin area. Ir Med J. 1982 Jul;75(7):240–242. [PubMed] [Google Scholar]
- Stamm W. E., Counts G. W., Running K. R., Fihn S., Turck M., Holmes K. K. Diagnosis of coliform infection in acutely dysuric women. N Engl J Med. 1982 Aug 19;307(8):463–468. doi: 10.1056/NEJM198208193070802. [DOI] [PubMed] [Google Scholar]
- Steensberg J., Bartels E. D., Bay-Nielsen H., Fanoe E., Hede T. Epidemiology of urinary tract diseases in general practice. Br Med J. 1969 Nov 15;4(5680):390–394. doi: 10.1136/bmj.4.5680.390. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Zilva J. F. Is unselective biochemical urine testing cost effective? Br Med J (Clin Res Ed) 1985 Aug 3;291(6491):323–325. doi: 10.1136/bmj.291.6491.323. [DOI] [PMC free article] [PubMed] [Google Scholar]
- de Dombal F. T., Leaper D. J., Staniland J. R., McCann A. P., Horrocks J. C. Computer-aided diagnosis of acute abdominal pain. Br Med J. 1972 Apr 1;2(5804):9–13. doi: 10.1136/bmj.2.5804.9. [DOI] [PMC free article] [PubMed] [Google Scholar]