Jen-Tzer Gau, Mesfin R. Shibeshi, I-Ju Lu, Maryum Rafique, Victor Heh, Deborah Meyer, Wayne R. Carlsen. Interexpert Agreement on Diagnosis of Bacteriuria and Urinary Tract Infection in Hospitalized Older Adults. J Am Osteopath Assoc 2009;109(4):220–226. doi: 10.7556/jaoa.2009.109.4.220.
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Context: Although bacteriuria with acute coexisting illness is common in hospitalized older adults, distinguishing it from urinary tract infection (UTI) can be challenging.
Objectives: To examine the rate of agreement between two geriatricians in distinguishing UTI from asymptomatic bacteriuria (ASB). To analyze the incidence of associated acute comorbidities and determine if an association exists between clinical manifestations and bacteriuria status on acute hospital admission.
Methods: Two physicians conducted a retrospective analysis of 296 inpatient records, including 142 records from age- and condition-matched nonbacteriuria control subjects. Using consensus criteria to diagnose UTI vs ASB, these independent experts evaluated inpatient records, including admission and discharge diagnoses as well as urinalysis results. A κ statistic was used to determine reviewer agreement. Risk assessment was measured by odds ratio with a 95% confidence interval.
Results: Expert agreement for the diagnosis of UTI and ASB was 98% and 44%, respectively. Agreement was reached at a level greater than chance (z=6.74, P<.001, κ=0.49). In the 30 cases where interexpert agreement was not reached, half of the subjects had acute pulmonary disease. Symptom crossover for this comorbid condition is the likely cause for lack of diagnostic agreement. Among other conditions observed, delirium was most common in UTI subjects.
Conclusion: Limited interexpert agreement seemed to result from difficulty in diagnosing patients who had no local symptoms but acute comorbid conditions with potential symptom crossover. Among the conditions observed in our sample population, delirium was most closely associated with UTI.
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