Customize your JAMA Network experience by selecting one or more topics from the list below.
Identify all potential conflicts of interest that might be relevant to your comment.
Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.
Err on the side of full disclosure.
If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.
Not all submitted comments are published. Please see our commenting policy for details.
Yin P, Kiss A, Leis JA. Urinalysis Orders Among Patients Admitted to the General Medicine Service. 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.
Create a personal account or sign in to: