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Validating the prediction of lower urinary tract infection in primary care: sensitivity and specificity of urinary dipsticks and clinical scores in women

Little, P., Turner, S., Rumsby, K., Jones, R., Warner, G., Moore, M., Lowes, J.A., Smith, H., Hawke, C., Leydon, G. and Mullee, M. (2010) Validating the prediction of lower urinary tract infection in primary care: sensitivity and specificity of urinary dipsticks and clinical scores in women British Journal of General Practice, 60, (576), 495 -500. (doi:10.3399/bjgp10X514747). (PMID:20594439).

Record type: Article


Background: Dipsticks are one of the most commonly used near-patient tests in primary care, but few clinical or dipstick algorithms have been rigorously developed.

Aim: To confirm whether previously documented clinical and dipstick variables and algorithms predict laboratory diagnosis of urinary tract infection (UTI).

Design of study: Validation study.

Setting: Primary care.

Method: A total of 434 adult females with suspected lower UTI had bacteriuria assessed using the European Urinalysis Guidelines.

Results: Sixty-six per cent of patients had confirmed UTI. The predictive values of nitrite, leucocyte esterase (+ or greater), and blood (haemolysed trace or greater) were confirmed (independent multivariate odds ratios = 5.6, 3.5, and 2.1 respectively). The previously developed dipstick rule — based on presence of nitrite, or both leucocytes and blood — was moderately sensitive (75%) but less specific (66%; positive predictive value [PPV] 81%, negative predictive value [NPV] 57%). Predictive values were improved by varying the cut-off point: NPV was 76% for all three dipstick results being negative; the PPV was 92% for having nitrite and either blood or leucocyte esterase. Urine offensive smell was not found to be predictive in this sample; for a clinical score using the remaining three predictive clinical features (urine cloudiness, dysuria, and nocturia), NPV was 67% for none of the features, and PPV was 82% for three features.

Conclusion: A clinical score is of limited value in increasing diagnostic precision. Dipstick results can modestly improve diagnostic precision but poorly rule out infection. Clinicians need strategies to take account of poor NPVs.

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More information

Published date: July 2010
Keywords: algorithms, clinical scoring, diagnosis, urinary tract infection, primary care, urinalysis
Organisations: Community Clinical Sciences


Local EPrints ID: 168275
ISSN: 0960-1643
PURE UUID: 525e5903-38b7-4be1-b509-5c9db2a9b299
ORCID for M. Moore: ORCID iD

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Date deposited: 26 Nov 2010 11:53
Last modified: 18 Jul 2017 12:23

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Author: P. Little
Author: S. Turner
Author: K. Rumsby
Author: R. Jones
Author: G. Warner
Author: M. Moore ORCID iD
Author: J.A. Lowes
Author: H. Smith
Author: C. Hawke
Author: G. Leydon
Author: M. Mullee

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