Validity, Accuracy, and Predictive Value of Urinary Tract Infection Signs and Symptoms in Individuals With Spinal Cord Injury on Intermittent Catheterization

J Spinal Cord Med, 2009 · DOI: · Published: November 1, 2009

Simple Explanation

This study aims to determine how well the signs and symptoms of urinary tract infections (UTIs) predict actual UTIs in individuals with spinal cord injuries (SCI) who use intermittent catheterization (IC). It also assesses how accurately these individuals can predict their own UTIs. The study found that certain UTI signs, such as cloudy urine and leukocytes in the urine, are more accurate in predicting a UTI than an individual's subjective assessment. Individuals were better at predicting when they did not have a UTI. The research highlights the importance of observable signs like urine appearance and smell in managing UTIs for SCI individuals using IC, especially in inpatient settings where urine is frequently monitored.

Study Duration

3 Months

Participants

56 community-based individuals on IC

Evidence Level

Prospective cohort

Key Findings

1
Cloudy urine had the highest accuracy (83.1%) in predicting UTI, while leukocytes in the urine showed the highest sensitivity (82.8%).
2
Fever had the highest specificity (99.0%) but a very low sensitivity (6.9%), making it a less reliable indicator of UTI in this population.
3
Subjects were able to predict their own UTI with an accuracy of 66.2%, with a negative predictive value (82.8%) substantially higher than the positive predictive value (32.6%).

Research Summary

This study evaluated the validity, accuracy, and predictive value of UTI signs and symptoms in individuals with SCI on IC. It also assessed the accuracy of individuals with SCI on IC at predicting their own UTI. The study found that "cloudy urine" had the highest accuracy, and "leukocytes in the urine" had the highest sensitivity. Subjects were better at predicting when they did not have a UTI than when they did have a UTI. The UTI signs and symptoms can predict a UTI more accurately than individual subjects can by using subjective impressions of their own signs and symptoms.

Practical Implications

Enhanced UTI Management

Assessing urine appearance and smell can improve UTI management for SCI individuals on IC, especially in inpatient settings.

Improved Diagnostic Accuracy

Focus on objective signs like cloudy urine and leukocytes in urine for more accurate UTI prediction compared to relying solely on subjective patient impressions.

Patient Education

Educate patients about the limited accuracy of self-prediction of UTIs to encourage prompt reporting of potential symptoms for timely intervention.

Study Limitations

1
The study did not rule out other concurrent medical conditions.
2
The study used a signs and symptoms questionnaire that had not been previously validated.
3
Relatively small sample size.

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