Accuracy of individuals with spinal cord injury at predicting urinary tract infections based on their symptoms.
OBJECTIVE
To determine whether individuals with spinal cord injuries (SCIs) who complain of symptoms of a urinary tract infection (UTI) actually have a UTI.


METHODS
A 9-month prospective case review.


METHODS
One hundred and forty-seven persons with SCI who presented to an outpatient urology clinic with symptoms they attributed to a UTI.


METHODS
Presence or absence of a UTI as determined by signs and symptoms of a UTI and a microscopic urine analysis (UA) for white blood cell (WBC) and bacterial colony counts.


METHODS
A UTI was defined as new onset of clinical signs and symptoms, significant bacterial colony counts in the urine, and evidence of tissue invasion with elevated WBC count > or = 10/high power field in the urine. Evaluation of each individual included history, physical examination, and UA with a culture and sensitivity. Evaluation for other medical problems was undertaken if history, physical examination, and laboratory results were not consistent with a UTI.


RESULTS
Sixty-one percent (90/147) of SCI persons were accurate in predicting the presence of a UTI based on their symptoms; 39% (57/147) were not accurate. In the group of 57 persons who were not accurate in predicting whether they had a UTI, 12 persons had other medical problems including fecal impaction, bowel obstruction, dehydration, heat intolerance, glucosuria, other infectious processes, respiratory problems, and neurologic problems. The remaining 45 had bacteriuria with no pyuria. The type of bladder management did not have an impact on the accuracy of predicting the presence or absence of a UTI (P = 0.03).


CONCLUSIONS
Individuals with SCI were frequently not accurate at predicting whether they had a UTI based on their symptoms.
Department of Urology, Kessler Institute for Rehabilitation, West Orange, New Jersey 07052, USA. tlinsenmeyer@kessler-rehab.com
Todd A
TA
Linsenmeyer
Anne
A
Oakley
D000328:Adult; D001437:Bacteriuria / Q000175:diagnosis / Q000453:epidemiology; D002408:Catheters, Indwelling / Q000382:microbiology; D015169:Colony Count, Microbial; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis* / Q000453:epidemiology; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011446:Prospective Studies; D012306:Risk; D012307:Risk Factors; D012648:Self Care; D012803:Sick Role; D013119:Spinal Cord Injuries / Q000150:complications* / Q000453:epidemiology; D001750:Urinary Bladder, Neurogenic / Q000150:complications* / Q000453:epidemiology; D014546:Urinary Catheterization / Q000009:adverse effects; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000453:epidemiology; D014556:Urine / Q000382:microbiology