Urinalysis is frequently performed in elderly females presenting to the Emergency Department with non-specific symptoms – owing to the general trend of non-focal constitutional complaints failing to localize disease as age increases. Understandably, then, this population is thoroughly subjected to increased diagnostic testing.
And, of course, if you run enough tests, you’ll find some “answers”. The question, of course, is whether these “answers” are in fact true positives, accurately reflecting underlying clinical disease. In this retrospective cohort of 153 elderly patients for whom a urine culture was sent along with a urinalysis, nearly half of urinalyses were false positives. Adding in the not-insignificant incidence of non-pathogenic asymptomatic bacteriuria, some of these positive culture results were likely false positives as well. The authors of this article feel this reflects substantial overdiagnosis and overtreatment.
This assertion is almost certainly correct. However, these authors are short of suggestions regarding the improvement of diagnostic accuracy. They suggest, perhaps, urine samples ought only be taken by catheter, and treatment be initiated only on positive culture results. However, more practical and expedient diagnostic methods are lacking.
“Overtreatment of Presumed Urinary Tract Infection in Older Women Presenting to the Emergency Department”
www.ncbi.nlm.nih.gov/pubmed/23590846