Dipstick urinalysis and the accuracy of the clinical diagnosis of urinary tract infection

The aim of this study was to determine whether dipstick urinalysis (DU) aug mented the accuracy of clinical assessment in the diagnosis of urinary trac t infection (UTI). The study was performed in 627 consecutive patients atte nding an adult emergency department (ED) in,whom the clinical diagnosis of UTI was considered. We excluded 227 patients. Treating clinicians gave the probability of a UTI on an ordinal and continuous scale, before and after D U. The assigned clinical probabilities were then compared to the results of formal urine culture. The areas under receiver-operating characteristic cu rves (AUC) were calculated. We found that clinical assessment alone was eff ective in detecting those patients with a UTI from those without (AUC 0.75; p < 0.0001), There was, however, a statistically significant difference in the accuracy of diagnosing UTI after DU (AUC 0.87; p < 0.0001), Proportion ately more patients with a moderate pre-test probability of UTI were re-ass igned to a different probability rating following DU, compared to the low o r high pre-test probability groups (p < 0.001), We conclude that DU in comb ination with clinical assessment Is a superior method for diagnosing UTI th an clinical assessment alone, (C) 2001 Elsevier Science Inc.