Diagnosis of urinary tract infection based on symptoms: how are likelihood ratios affected by age? a diagnostic accuracy study

Objectives The aim of this study was to investigate the impact of age on the diagnostic properties of typical symptoms of urinary tract infection (UTI) in women presenting in general practice with symptoms suggestive of UTI with significant bacteriuria as the reference standard.Design Diagnostic acc...

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Autores principales:	Volkert Siersma, Gloria Cristina Cordoba, Anne Holm
Formato:	article
Lenguaje:	EN
Publicado:	BMJ Publishing Group 2021
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/d169d308b5404cc9a2a6861b2456df44
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spelling	oai:doaj.org-article:d169d308b5404cc9a2a6861b2456df442021-11-18T10:30:04ZDiagnosis of urinary tract infection based on symptoms: how are likelihood ratios affected by age? a diagnostic accuracy study10.1136/bmjopen-2020-0398712044-6055https://doaj.org/article/d169d308b5404cc9a2a6861b2456df442021-01-01T00:00:00Zhttps://bmjopen.bmj.com/content/11/1/e039871.fullhttps://doaj.org/toc/2044-6055Objectives The aim of this study was to investigate the impact of age on the diagnostic properties of typical symptoms of urinary tract infection (UTI) in women presenting in general practice with symptoms suggestive of UTI with significant bacteriuria as the reference standard.Design Diagnostic accuracy study.Setting General practice, Copenhagen, Denmark.Participants Adult 15 years or older. Women presenting in general practice with symptoms suggestive of UTI where urine was collected for investigation.Primary and secondary outcome measures Accuracy of four symptoms of UTI (dysuria, frequency, urge and abdominal pain) in six different age groups.Results 90 practices included 1178 adult women. The prevalence of bacteriuria varied between 30% in women aged 30–44 years and 67% in women aged 75–89 years. The likelihood ratios for dysuria varied between age groups with the best performance in women aged 15–29 (positive likelihood ratio (pLR): 1.62 (1.30–1.94), negative likelihood ratio (nLR): 0.36 (0.19–0.54)) and women aged 30–44 (pLR: 1.74 (1.30–2.17), nLR: 0.48 (0.27–0.68)). CIs included or approximated one for the remaining symptoms in most age groups. When symptoms were combined to calculate post-test probabilities, the combined effect of the varying prevalence of bacteriuria and the varying diagnostic values resulted in a large variation of the post-test probabilities between age groups.Conclusions The diagnostic value of symptoms of UTI as well as the prevalence of bacteriuria in women presenting to general practice with suspected UTI vary between age groups with considerable clinical implications. Diagnostic studies should take demographics such as age into consideration.Trial registration number ClinicalTrials.gov: NCT02698332.Volkert SiersmaGloria Cristina CordobaAnne HolmBMJ Publishing GrouparticleMedicineRENBMJ Open, Vol 11, Iss 1 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R Volkert Siersma Gloria Cristina Cordoba Anne Holm Diagnosis of urinary tract infection based on symptoms: how are likelihood ratios affected by age? a diagnostic accuracy study
description	Objectives The aim of this study was to investigate the impact of age on the diagnostic properties of typical symptoms of urinary tract infection (UTI) in women presenting in general practice with symptoms suggestive of UTI with significant bacteriuria as the reference standard.Design Diagnostic accuracy study.Setting General practice, Copenhagen, Denmark.Participants Adult 15 years or older. Women presenting in general practice with symptoms suggestive of UTI where urine was collected for investigation.Primary and secondary outcome measures Accuracy of four symptoms of UTI (dysuria, frequency, urge and abdominal pain) in six different age groups.Results 90 practices included 1178 adult women. The prevalence of bacteriuria varied between 30% in women aged 30–44 years and 67% in women aged 75–89 years. The likelihood ratios for dysuria varied between age groups with the best performance in women aged 15–29 (positive likelihood ratio (pLR): 1.62 (1.30–1.94), negative likelihood ratio (nLR): 0.36 (0.19–0.54)) and women aged 30–44 (pLR: 1.74 (1.30–2.17), nLR: 0.48 (0.27–0.68)). CIs included or approximated one for the remaining symptoms in most age groups. When symptoms were combined to calculate post-test probabilities, the combined effect of the varying prevalence of bacteriuria and the varying diagnostic values resulted in a large variation of the post-test probabilities between age groups.Conclusions The diagnostic value of symptoms of UTI as well as the prevalence of bacteriuria in women presenting to general practice with suspected UTI vary between age groups with considerable clinical implications. Diagnostic studies should take demographics such as age into consideration.Trial registration number ClinicalTrials.gov: NCT02698332.
format	article
author	Volkert Siersma Gloria Cristina Cordoba Anne Holm
author_facet	Volkert Siersma Gloria Cristina Cordoba Anne Holm
author_sort	Volkert Siersma
title	Diagnosis of urinary tract infection based on symptoms: how are likelihood ratios affected by age? a diagnostic accuracy study
title_short	Diagnosis of urinary tract infection based on symptoms: how are likelihood ratios affected by age? a diagnostic accuracy study
title_full	Diagnosis of urinary tract infection based on symptoms: how are likelihood ratios affected by age? a diagnostic accuracy study
title_fullStr	Diagnosis of urinary tract infection based on symptoms: how are likelihood ratios affected by age? a diagnostic accuracy study
title_full_unstemmed	Diagnosis of urinary tract infection based on symptoms: how are likelihood ratios affected by age? a diagnostic accuracy study
title_sort	diagnosis of urinary tract infection based on symptoms: how are likelihood ratios affected by age? a diagnostic accuracy study
publisher	BMJ Publishing Group
publishDate	2021
url	https://doaj.org/article/d169d308b5404cc9a2a6861b2456df44
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Diagnosis of urinary tract infection based on symptoms: how are likelihood ratios affected by age? a diagnostic accuracy study

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