title: Assessment of the performance of the American Urological Association symptom score in 2 distinct patient populations.
abstract: OBJECTIVE
  Recent research suggests that low education and illiteracy may drive misunderstanding of the American Urological Association Symptom Score, a key tool in the American Urological Association benign prostatic hyperplasia guidelines. It is unclear whether misunderstanding is confined to patients of low socioeconomic status. Therefore, we reevaluated the prevalence and impact of this misunderstanding in a county vs university hospital population.
  
  
  METHODS
  This prospective study involved 407 patients from a county hospital and a university hospital who completed the American Urological Association Symptom Score as self-administered and then as interviewer administered. Responses were compared by calculating correlation coefficients and weighted kappa statistics to assess patient understanding of the American Urological Association Symptom Score. Multivariate logistic regression analyses were used to examine the association between patient characteristics and poor understanding of the American Urological Association Symptom Score.
  
  
  RESULTS
  Of the patients 72% understood all 7 American Urological Association Symptom Score questions. Of the measured demographic variables only education level significantly affected this understanding. Compared to patients with more than 12 years of education county hospital patients with less than 9 years of education were 57.06 times more likely to misunderstand the American Urological Association Symptom Score (95% CI 14.32-329.34) while university hospital patients with less than 9 years of education were 38.27 times more likely to misunderstand the American Urological Association Symptom Score (95% CI 1.69-867.83). Of county hospital patients 31% and of university hospital patients 21% significantly misrepresented their symptom severity according to current guidelines.
  
  
  CONCLUSIONS
  Patients with low education regardless of location are more likely to misunderstand the American Urological Association Symptom Score, misrepresent their symptoms and, therefore, receive inappropriate treatment.
authors.affiliation: School of Medicine Department of Urology, Emory University, Atlanta, Georgia, USA.
authors.forename: Timothy V
authors.initials: TV
authors.lastname: Johnson
authors.forename: Evan D
authors.initials: ED
authors.lastname: Schoenberg
authors.forename: Ammara
authors.initials: A
authors.lastname: Abbasi
authors.forename: Samantha S
authors.initials: SS
authors.lastname: Ehrlich
authors.forename: Renee
authors.initials: R
authors.lastname: Kleris
authors.forename: Ashli
authors.initials: A
authors.lastname: Owen-Smith
authors.forename: Kristin
authors.initials: K
authors.lastname: Gunderson
authors.forename: Viraj A
authors.initials: VA
authors.lastname: Master
mesh_terms: D004522:Educational Status; D006766:Hospitals, County; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D053448:Prostatism / Q000175:diagnosis*; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires / Q000592:standards*; D014481:United States