Urinalysis Orders Among Patients Admitted to the General Medicine Service | Emergency Medicine | JAMA Internal Medicine | JAMA Network
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    1 Comment for this article
    Intriguing study
    Andrew Fenton, MD | Queen of the Valley Medical Center
    I would very much like to see the House of Medicine reach consensus regarding the definition of \"symptomatic\" UTI. Currently, falls, weakness, ALOC/AMS, etc. all get a UA which is commonly positive and they are treated. This often satisfies patients and families. It also delays throughput in EDs, increases bacterial antibiotic resistance, and may falsely reassure providers and patients. There is great disparity among physicians how to manage this population and when to send the urinalysis.<br/><br/>Andrew Fenton, MD<br/>Napa Valley Emergency Medical Group<br/>Medical Director, Emergency Department<br/>Chair, Dept. of Family & Emergency Medicine<br/>Queen of the Valley Medical Center
    Research Letter
    Less Is More
    October 2015

    Urinalysis Orders Among Patients Admitted to the General Medicine Service

    Author Affiliations
    • 1Department of Medicine, University of Toronto, Toronto, Ontario, Canada
    • 2Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
    • 3Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
    • 4Division of Infectious Diseases, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
    • 5Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada
    JAMA Intern Med. 2015;175(10):1711-1713. doi:10.1001/jamainternmed.2015.4036

    Urinalysis (UA) is a frequently ordered rapid screening test to exclude the presence of a urinary tract infection (UTI) among patients admitted to the general medicine (GM) service from the emergency department. Despite its excellent negative predictive value,1 a positive UA result is nonspecific because it occurs in as many as 90% of asymptomatic elderly patients.2,3 We hypothesized that overuse of UA in the emergency department contributes to overdiagnosis and excessive use of antibiotics for UTI among patients admitted to the GM service.

    We conducted a prospective cohort study of consecutive adult patients to assess the appropriateness of UA orders on admission to the GM service of a large tertiary care center for 4 consecutive weeks in September to October 2014 and 3 consecutive weeks in January 2015. Each patient was assessed within 24 hours for indications for UA, including symptoms of UTI based on guidelines for patients with and without urinary catheters3,4 or acute kidney injury, defined as a 2-fold rise in serum creatinine levels.5 We recorded the frequency of empirical therapy for UTI, orders for urine culture (UC), and antimicrobial prescriptions based on UC results. We compared the proportion of patients who underwent UC or received antibiotic treatment (empirical or by UC result) using χ2 tests based on a positive or negative UA result. We assessed predictors of UA orders without indication (UTI or acute kidney injury) using a multivariable logistic regression model with 75 years or older, sex, residence in long-term care, diabetes mellitus, dementia, or presence of 3 or more comorbidities as variables. We obtained approval from the research ethics board of Sunnybrook Health Sciences Center. All data were deidentifed and informed consent was waived.