Accuracy of individuals with spinal cord injury at predicting urinary tract infections based on their symptoms

Objective: To determine whether individuals with spinal cord injuries (SCIs) who complain of symptoms of a urinary tract infection (UTI) actually have a UTI. Design: A 9-month prospective case review. Participants: One hundred and forty-seven persons with SCI who presented to an outpatient urology clinic with symptoms they attributed to a UTI. Main Outcome Measures: Presence or absence of a UTI as determined by signs and symptoms of a UTI and a microscopic urine analysis (UA) for white blood cell (WBC) and bacterial colony counts. Methods: A UTI was defined as new onset of clinical signs and symptoms, significant bacterial colony counts in the urine, and evidence of tissue invasion with elevated WBC count greater than or equal to 10/high power field in the urine. Evaluation of each individual included history, physical examination, and UA with a culture and sensitivity. Evaluation for other medical problems was undertaken if history, physical examination, and laboratory results were not consistent with a UTI. Results: Sixty-one percent (90/147) of SCI persons were accurate in predicting the presence of a UTI based on their symptoms; 39% (57/147) were not accurate. In the group of 57 persons who were not accurate in predicting whether they had a UTI, 12 per-sons had other medical problems including fecal impaction, bowel obstruction, dehydration, heat intolerance, glucosuria, other infectious processes, respiratory problems, and neurologic problems. The remaining 45 had bacteriuria with no pyuria. The type of bladder management did not have an impact on the accuracy of predicting the presence or absence of a UTI (P = 0.03). Conclusion: Individuals with SCI were frequently not accurate at predicting whether they had a UTI based on their symptoms.