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December 1985

Use of Clinical Findings in the Diagnosis of Urinary Tract Infection in Women

Author Affiliations

From the Department of Internal Medicine (Drs Wigton, Hoellerich, and Ornato), Health Systems Computing (Ms Cheng), and Hospital Administration (Ms Leu and Mr Mazzotta), University of Nebraska Medical Center, Omaha. Dr Hoellerich is now a resident at Johns Hopkins University, Baltimore.

Arch Intern Med. 1985;145(12):2222-2227. doi:10.1001/archinte.1985.00360120094016

To develop a decision rule for predicting urinary culture results in patients suspected of having urinary tract infection, we used discriminant analysis to identify the optimum combination of clinical findings. Thirty variables identified in a pilot study were recorded from 248 patients in a second study. Five findings were independent predictors of positive urinary culture: history of urinary tract infection, back pain, microscopic pyuria, hematuria, and bacteriuria. An additive decision rule that assigned one point for each of the five variables was tested in a third group of 258 patients. These scores stratified patients into subsets with increasing likelihood of positive culture. Higher scores identified patients who can confidently be treated without documentation of bacteriuria. If the rule applies successfully to other populations, cost savings could result from identification of patients who do not require quantitative urinary culture to demonstrate significant bacteriuria.

(Arch Intern Med 1985;145:2222-2227)