ABSTRACT
Objetivo. Determinar la validez de criterio y el valor predictivo del síntoma disuria para el diagnóstico de infección del tracto urinario (ITU). Diseño. Estudio transversal para evaluación de un síntoma. Emplazamiento. Seis consultas de atención primaria (4 de zona urbana y 2 rurales) del Área 11 de Salud de Madrid. Participantes. Se incluyeron 232 pacientes mayores de 14 años que acudieron a consulta durante 6 meses consecutivos (116 consultaron por disuria y 116 asintomáticos para el síntoma disuria). A todos se les solicitó sedimento y urocultivo. Mediciones y resultados. Se estableció diagnóstico de ITU con urocultivo positivo o sedimento con leucocituria y bacteriuria. Se estudio la sensibilidad (S), especificidad (E), el valor predictivo positivo (VPP), el valor predictivo negativo (VPN), el cociente de probabilidades positivo (CPP) y el cociente de probabilidades negativo (CPN) de la disuria para el diagnóstico de ITU. La edad media fue de 54 años (rango, 19-82), siendo un 73 por ciento mujeres. No había diferencias significativas de edad y sexo entre casos y no casos (p > 0,1). La disuria mostró una S del 96 por ciento (IC del 95 por ciento, 86-98 por ciento), una E del 69 por ciento (IC del 95 por ciento, 61-76 por ciento) y un CPP de 3,1 (IC del 95 por ciento, 2,7-3,5) para el diagnóstico de ITU. En el subgrupo de mujeres la S fue del 95 por ciento (IC del 95 por ciento, 84-99 por ciento) y la E del 67 por ciento (IC del 95 por ciento, 58-75 por ciento). Se calculó para este síntoma un VPP del 30 por ciento (IC del 95 por ciento, 22-40 por ciento) y un VPN del 99 por ciento (IC del 95 por ciento, 95-100 por ciento). Conclusiones. Es poco probable el diagnóstico de ITU sin el síntoma disuria. La mayoría de los pacientes con ITU presentan disuria; sin embargo, este síntoma aislado no nos permite establecer el diagnostico de infección urinaria (AU)
Subject(s)
Male , Female , Humans , Urinary Tract Infections , Urination Disorders , Reproducibility of Results , Case-Control Studies , Cross-Sectional Studies , Predictive Value of TestsABSTRACT
OBJECTIVE: To assess the validity of criterion and predictive value of dysuria for the diagnosis of UTI. DESIGN: Cross-sectional study to assess a symptom. SETTING: Six general medicine clinics (four urban clinics and two rural clinics) in the 11th Health Area in Madrid. PATIENTS: The sample consists of 232 patients aged above fourteen who consulted during six consecutive months (116 of them reported having dysuria and 116 were asymptomatic). MEASUREMENTS AND MAIN RESULTS: The diagnosis of urinary tract infections (UTI) was achieved through positive urine cultures or bacteriuria and leukocyturia in the centrifuged urine sediment. The sensitivity (S) of dysuria analysis for the diagnosis of UTI, its specificity (E), its predictive value (VP), and its probability coefficient (CP) were considered. Average age of the sample was 54 years old (range 19-82); 73% of the patients were female. No statistically significative difference of sex and age was found between cases and non-cases (p > 0.1). Dysuria showed a 96% of sensitivity (95% CI, 86-98%), a 69% of E (95% CI, 61-76%) and 3.1 of CPP (95% CI, 2.7-3.5) for UTI diagnosis. In the women subgroup there was 95% of sensitivity (95% CI, 84-99%) and 67% of E (95% CI, 58-75%). A positive predictive value of 30% (95% CI, 22-40) and a negative predictive value of 99% (95% CI, 95-100) were estimated for this symptom. CONCLUSIONS: The diagnosis of urinary tract infections is unlikely in the absence of dysuria, but to treat all dysuria patients as UTI entails a high rate of overtreatment.
Subject(s)
Urinary Tract Infections/complications , Urination Disorders/etiology , Case-Control Studies , Cross-Sectional Studies , Female , Humans , Male , Predictive Value of Tests , Reproducibility of Results , Urinary Tract Infections/diagnosis , Urinary Tract Infections/microbiologyABSTRACT
OBJECTIVES: To find the clinical and epidemiological characteristics of HIV-positive patients and to study the possible differences between patients attended by primary care teams (PCT) and by the hospital specialist unit (SU). DESIGN: A descriptive cross-sectional study. SETTING: Six PCTs in Villaverde, Usera and Carabanchel (Madrid). PATIENTS: Those infected with HIV and in the morbidity records between January 1992 and January 1995. MEASUREMENTS AND MAIN RESULTS: 274 cases were studied. The most important risk practice was being IDU (intravenous drugs user) (80.3%). The most definitive and linked AIDS-related illness was Tuberculosis (39.7%). Patients treated with Zidovudine (or AZT) were monitored by PCTs (p = 0.004), as were those not needing day-hospital treatment (p = 0.0005). CONCLUSIONS: HIV infection in our environment follows the typical clinical and epidemiological pattern of this country: transmitted by IDUs, with its most frequent associated infection being tuberculosis. With the exception of AZT or day-hospital treatment, its clinical and epidemiological features are similar in PCTs and SUs. Information and responsible participation of PCT professionals in caring for HIV-positive patients are the key strategies for guaranteeing the quality of health care delivery.
