Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, United Kingdom.
J Infect. 2018 Nov;77(5):379-390. doi: 10.1016/j.jinf.2018.06.012. Epub 2018 Jun 30.
To critically appraise and evaluate the diagnostic value of symptoms and signs in identifying UTI in older adult outpatients, using evidence from observational studies.
We searched Medline and Medline in process, Embase and Web of Science, from inception up to September 2017. We included studies assessing the diagnostic accuracy of symptoms and/or signs in predicting UTI in outpatients aged 65 years and above. Study quality was assessed using the QUADAS-2 tool.
We identified 15 eligible studies of variable quality, with a total of 12,039 participants (range 65-4259), and assessed the diagnostic accuracy of 66 different symptoms and signs in predicting UTI. A number of symptoms and signs typically associated with UTI, such as nocturia, urgency and abnormal vital signs, were of limited use in older adult outpatients. Inability to perform a number of acts of daily living were predictors of UTI: For example, disability in feeding oneself, + ve LR: 11.8 (95% CI 5.51-25.2) and disability in washing one's hands and face, + ve LR: 6.84 (95% CI 4.08-11.5).
The limited evidence of varying quality shows that a number of symptoms and signs traditionally associated with UTI may have limited diagnostic value in older adult outpatients.
利用观察性研究证据，批判性地评估和评价症状和体征在识别老年门诊患者尿路感染中的诊断价值。
我们检索了 Medline 和 Medline 正在处理中的文献、Embase 和 Web of Science，检索时间截至 2017 年 9 月。我们纳入了评估症状和/或体征预测 65 岁及以上门诊患者尿路感染的诊断准确性的研究。使用 QUADAS-2 工具评估研究质量。
我们确定了 15 项质量不同的合格研究，共有 12039 名参与者（范围 65-4259 岁），并评估了 66 种不同症状和体征预测尿路感染的诊断准确性。一些与尿路感染相关的典型症状和体征，如夜尿、尿急和异常生命体征，在老年门诊患者中的使用效果有限。无法完成一些日常生活活动是尿路感染的预测因素：例如，进食自理能力障碍，+LR：11.8（95%CI 5.51-25.2）和洗脸洗手自理能力障碍，+LR：6.84（95%CI 4.08-11.5）。
质量参差不齐的有限证据表明，一些传统上与尿路感染相关的症状和体征在老年门诊患者中的诊断价值可能有限。
