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OBJECTIVES: To critically appraise and evaluate the diagnostic value of symptoms and signs in identifying UTI in older adult outpatients, using evidence from observational studies. METHODS: We searched Medline and Medline in process, Embase and Web of Science, from inception up to September 2017. We included studies assessing the diagnostic accuracy of symptoms and/or signs in predicting UTI in outpatients aged 65 years and above. Study quality was assessed using the QUADAS-2 tool. RESULTS: We identified 15 eligible studies of variable quality, with a total of 12,039 participants (range 65 to 4,259), and assessed the diagnostic accuracy of 66 different symptoms and signs in predicting UTI. A number of symptoms and signs typically associated with UTI, such as nocturia, urgency and abnormal vital signs, were of limited use in older adult outpatients. Inability to perform a number of acts of daily living were predictors of UTI: For example, disability in feeding oneself, +ve LR: 11.8 (95% CI 5.51-25.2) and disability in washing one's hands and face, +ve LR: 6.84 (95% CI 4.08-11.5). CONCLUSIONS: The limited evidence of varying quality shows that a number of symptoms and signs traditionally associated with UTI may have limited diagnostic value in older adult outpatients.

Original publication

DOI

10.1016/j.jinf.2018.06.012

Type

Journal article

Journal

J Infect

Publication Date

28/06/2018

Keywords

Diagnosis, Older adults, Symptoms and signs, Urinary tract infection