Pregnant patient in the emergency department: An observational investigation of predictive values of symptoms and lab measures in predicting culture confirmed urinary tract infection.

Many women in their first trimester present to the Emergency Department (ED) for evaluation. Urinalysis is a common test performed with these patients to evaluate for possible UTI. There are no clear results to determine if a patient requires antibiotic in the ED vs waiting for the culture result to start antibiotics. We prospectively studied a convenience sample of 198 women in their first trimester of pregnancy presenting to a community ED recording standard symptoms and lab analysis and then compared these results to the urine culture. We determined that no single symptom was significantly sensitive nor specific for ruling in or out UTI. Overall, the presence of Nitrites was the most significant with a specificity of 98.6%, NPV of 81.9% and PPV of 86.6%. Presence of specific historical findings, namely dysuria (88% specificity) and hematuria (93% specificity) performed well for predicting culture positive UTI but performed poorly in ruling out this condition. The diagnosis of a culture confirmed UTI in the ED cannot be reliably predicted using symptomology or labs values other than nitrates.