title: Validity, accuracy, and predictive value of urinary tract infection signs and symptoms in individuals with spinal cord injury on intermittent catheterization.
abstract: OBJECTIVE
  To determine the validity, accuracy, and predictive value of the signs and symptoms of urinary tract infection (UTI) for individuals with spinal cord injury (SCI) using intermittent catheterization (IC) and the accuracy of individuals with SCI on IC at predicting their own UTI.
  
  
  METHODS
  Prospective cohort based on data from the first 3 months of a 1-year randomized controlled trial to evaluate UTI prevention effectiveness of hydrophilic and standard catheters.
  
  
  METHODS
  Fifty-six community-based individuals on IC.
  
  
  METHODS
  Presence of UTI as defined as bacteriuria with a colony count of at least 10(5) colony-forming units/mL and at least 1 sign or symptom of UTI.
  
  
  METHODS
  Analysis of monthly urine culture and urinalysis data combined with analysis of monthly data collected using a questionnaire that asked subjects to self-report on UTI signs and symptoms and whether or not they felt they had a UTI.
  
  
  RESULTS
  Overall, "cloudy urine" had the highest accuracy (83.1%), and "leukocytes in the urine" had the highest sensitivity (82.8%). The highest specificity was for "fever" (99.0%); however, it had a very low sensitivity (6.9%). Subjects were able to predict their own UTI with an accuracy of 66.2%, and the negative predictive value (82.8%) was substantially higher than the positive predictive value (32.6%).
  
  
  CONCLUSIONS
  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. Subjects were better at predicting when they did not have a UTI than when they did have a UTI.
authors.affiliation: Jackson Memorial Hospital, Department of Rehabilitation Medicine, 1120 NW 14th Street, Miami, FL 33136, USA. luizmassa1@gmail.com
authors.forename: Luiz M
authors.initials: LM
authors.lastname: Massa
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Hoffman
authors.forename: Diana D
authors.initials: DD
authors.lastname: Cardenas
mesh_terms: D006801:Humans; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012111:Residence Characteristics; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000175:diagnosis* / Q000503:physiopathology*; D013234:Stem Cells; D013997:Time Factors; D014546:Urinary Catheterization / Q000009:adverse effects*; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000209:etiology*