Female patient self-diagnosis compared with emergency physician diagnosis of urinary tract infection.

BACKGROUND: Urinary tract infection (UTI) is a common emergency department (ED) complaint and self-diagnosis may be possible.

OBJECTIVE: The objective was to compare female patient self-diagnosis compared with emergency physician (EP) diagnosis of UTI.

METHODS: This was a prospective cohort study in a single urban ED. Women aged 18-64 years with a chief complaint of UTI, urinary frequency, or dysuria who presented to an urban academic ED were enrolled in a convenience sample fashion. Patients completed a written four-question survey by an ED greeter before triage. Charts of respondents were reviewed for demographic, laboratory, and EP diagnosis.

RESULTS: Fifty women were enrolled; 100% of patients who were approached participated in the study. Mean age was 33.7 years (standard deviation 13.8). Forty-three patients (86%) had a history of UTI. Forty-one patients (82%) thought they had a UTI on the index visit. Thirty patients (60%) preferred to buy over-the-counter antibiotics for their symptoms instead of seeing a doctor. Fifteen patients (30%) identified a specific antibiotic they would take. Of the 41 patients who thought they had a UTI, 25 (61%) were given that diagnosis. Of the 30 patients who would have preferred over-the-counter antibiotics, 20 (67%) were actually prescribed them. Agreement between EP and women's final impressions was low (κ = 0.11).

CONCLUSIONS: There was poor agreement between EP diagnosis and self-diagnosis of UTI. In our ED population, women should be encouraged to seek medical attention to confirm the diagnosis.