Is Routine Pregnancy Testing Necessary in Women with Suspected UTI?

Objective: To determine if women of reproductive age who present to the Emergency Department (ED) with urinary tract infection (UTI) symptoms can accurately predict their pregnancy status. Methods: We performed a retrospective study of women who presented to the ED with UTI symptoms (dysuria, frequency, or urgency). Consecutive females aged 18-49 years were referred from triage to a computer kiosk in the waiting room. The kiosk asked all patients in oral and written format: "Are you pregnant, worried you might be pregnant or have you missed your last period?" Patient responses about pregnancy risk were compared to urine pregnancy test results. Test characteristics and post-test probabilities were calculated. Results: From a total of 300 eligible subjects, 216 received a pregnancy test, of which 10 were positive, giving a pregnancy prevalence of 5%. Of 196 patients who reported no pregnancy risk, 4 were found to be pregnant, yielding a negative posttest probability of pregnancy = 2.0% (95%CI 0.8-5.1). Among the 155 women diagnosed with a UTI, 6 were pregnant, giving a prevalence of 4%. Of the 144 patients who reported no pregnancy risk, 2 were found to be pregnant, yielding a negative posttest probability of 1.4% (95% CI 0.4-4.9). Conclusions: Adult women presenting to the ED with UTI symptoms who report no pregnancy risk have a 2% or lower probability of actually being pregnant. We believe this level of accuracy to be sufficient for routine clinical practice, and consider it is reasonable to initiate empiric antibiotic therapy without diagnostic pregnancy testing in such patients.