>FROM: Paul Galloway, INTERNET:[log in to unmask]
>. Has anyone on GP-UK done any similar audit/research ?
I wrote an article on UTI diagnosis in JRCGP in 1987:
A simple scoring system for evaluating symptoms, history and urine dipstick
testing in diagnosis of urinary tract infection. Journal of the Royal College of
General Practitioners 1987 (37) 100-104. FF Dobbs, DM Fleming
An update to the scoring system was published in the BMJ in 1993, incorporating
leucocyte esterase:
Dipstick testing easy and informative. (letter) British Medical Journal 1993
(306) 1543. F Dobbs, D Fleming
The scores calculated from 456 patients' data are as follows:
Table 1. B-scores for predicting bacteriuria in adult women
Present Absent
Symptoms
Frequency +1 -3
Nocturia +2 -2
Dysuria +1 -1
Urgency +1 -1
Haematuria +3 0
Offensive Urine +2 0
Nausea -2 0
History
Symptoms for 9 days or less +1 -3
Previous IVP +2 0
Dipstick test
Protein +3 -1
Blood +3 -3
Nitrite +11 -2
Leucocyte esterase +2 -5
Population level +2
(If 60% of suspected UTIs are infected)
The study found that using the B-score system would reduce the number of missed
infections by 58% and would also reduce the number of women treated
unnecessarily with antibiotic by 18%.
Even a couple of months of using the B-score system could improve your
diagnostic skills, as the scores highlight the data items which are most useful
in differentiating between infection and urethral syndrome.
Best Wishes
Frank Dobbs
Department of Primary Care and General Practice
University of Plymouth
PL4 8AA
01752 - 232995
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