To the Editor: In their Rational Clinical Examination
article, Dr Bent and colleagues1 evaluated
the accuracy and precision of the clinical history and examination for the
diagnosis of urinary tract infection (UTI). Clinicians often rely on a single
symptom or sign to establish the diagnosis,2
so it is important that they be aware of the pretest probability. However,
the pretest probability of infection that Bent et al cite (48%) seems very
high to us. One of us (T.F.) has calculated a 25% to 29% pretest probability
of UTI in patients attending 8 primary care practices in the United Kingdom.2 We are also aware of another study that found a
pretest probability of 35%.3 We therefore
reexamined the studies that Bent et al used, added the study by Dobbs and
Fleming,3 and performed a meta-analysis
on only those articles that exclusively studied women with symptoms suggestive
of UTI.4- 6
We excluded studies if they included men2,7,8
or women with suspected vaginal infection.9
There was no heterogeneity (P = .12), so a fixed-effects
model was used. This analysis yielded a combined pretest probability estimate
of 35.6% (95% confidence interval, 32.1%-39.0%).
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