The Improving Outcomes of UTI Management in Long-Term Care Project (IOU) Consensus Guidelines for the Diagnosis of Uncomplicated Cystitis in Nursing Home Residents.
David A Nace, Subashan K Perera, Joseph T Hanlon and 8 others
PMID 30037743WHAT IT FOUND
Painful urination, urinary frequency, urinary urgency, suprapubic pain and gross hematuria were the consensus signs and symptoms of uncomplicated cystitis in non-catheterized nursing home residents.
These are expert recommendations, not tested interventions.
Key findings
01Dysuria reached consensus for inclusion as a sign or symptom of uncomplicated cystitis.
02Urinary frequency, urinary urgency, suprapubic pain and gross hematuria reached consensus for inclusion.
03The panel failed to reach a 2/3 majority that dysuria alone, hematuria with frequency or urgency without dysuria, or suprapubic pain with frequency or urgency without dysuria was sufficient.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The guideline is based on consensus from 20 physicians, not on outcomes in nursing home residents. The evidence base was limited, so the panel relied on expert opinion. No gold standard for UTI diagnosis exists, so the algorithm's diagnostic accuracy is unknown. The algorithm has not been tested in patients in this paper; validation is ongoing. The panel did not agree that dysuria alone or the tested combinations without dysuria were sufficient minimal criteria. The algorithm addresses non-catheterized residents and does not define criteria for catheter-associated or complicated UTI.
Declared interests
The supplied conflict statement says the named authors reported no conflicts. The publication types list NIH and U.S. Government Public Health Service support. The supplied text does not state that a sponsor designed or wrote the manuscript.
The easy way to misread this
Do not read the five symptoms as a validated diagnostic test. They are expert consensus, not tested in patients, and the paper states diagnostic accuracy cannot be determined because no gold standard exists.