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Master Thesis

Diagnostic des cystites simples en médecine générale : quel est l'apport de la bandelette urinaire ?

Abstract : Objective: To evaluate the gain in diagnostic accuracy brought by urinary dipstick in primary care to diagnose urinary tract infection (UTI) compared with that of symptoms combinations alone. In addition, it aimed at determining the influence of different reference standard of bacteriuria on dipstick's performances. Design: A systematic review of the diagnostic accuracy of urinary symptoms in primary care (PubMed, Embase and Pascal) and a meta-analysis for predictive values of every symptom combinations and dipstick were performed so as to evaluate the gain in diagnostic accuracy. Eligibility criteria for selecting studies were cross-sectional studies carried out in primary care which evaluated the diagnostic accuracy of urinary symptoms compared with urine culture to diagnose uncomplicated UTI in symptomatic women. Studies should report data on the prevalence, true and false positive, true and false negative so as to calculate the likelihood ratios of each symptom. Results: The gain in positive predictive value (PPV) using dipstick was positive for all symptom combinations whereas the gain in negative predictive value (NPV) decreased with increasing number of symptoms. Excluding "lower abdominal pain", the gain in NPV was low or negative for three or more symptoms (average gain of 8,08% ±4,89 with a threshold of 105CFU/mL, 6,70%±10,98 with 103 et 8,85%±12,72 à 102). The decrease of reference standard of bacteriuria from 105 to 102CFU/mL led to an increase of the gain in PPV and a decrease of the gain in NPV of dipstick. Conclusion: The use of dipstick cannot be justified in primary care when three or symptoms are present (excluding "lower abdominal pain") because of a low or negative gain in diagnostic accuracy. In these situations, the moderate NPV of the test cannot rule out the diagnosis of UTI.
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Master Thesis
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Submitted on : Monday, November 26, 2012 - 12:06:20 PM
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Estelle Viala. Diagnostic des cystites simples en médecine générale : quel est l'apport de la bandelette urinaire ?. Médecine humaine et pathologie. 2011. ⟨dumas-00757109⟩

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