Dobbs and Fleming developed a scoring system using symptoms, history and urine dipstick ("SHU") findings to estimate probability of a urinary tract infection for a patient seen in a primary care setting. The authors are from Birmingham in England.
Patient population groups:
(1) children 0 to 14 years
(2) nonpregnant women 15 to 49 years of age
(3) nonpregnant women 50 years of age or older
Pregnant women and males over the age of 14 are not included in the scoring system.
Symptoms:
(1) frequency
(2) nocturia
(3) dysuria
(4) urgency
(5) hematuria
(6) offensive smelling urine
(7) nausea
History:
(8) duration of symptoms in days
(9) history of previous urinary tract infection (UTI)
(10) history of previous intravenous pyelogram (IVP)
Dipstick urinalysis testing:
(11) protein
(12) blood
(13) nitrite
|
Parameter for Children <= 14 Years of Age |
Finding |
Points |
|---|---|---|
|
frequency |
present |
+2 |
|
|
absent |
-2 |
|
nocturia |
present |
0 |
|
|
absent |
0 |
|
dysuria |
present |
+3 |
|
|
absent |
-3 |
|
urgency |
present |
0 |
|
|
absent |
0 |
|
hematuria |
present |
0 |
|
|
absent |
0 |
|
offensive smelling urine |
present |
+2 |
|
|
absent |
0 |
|
nausea |
present |
-2 |
|
|
absent |
0 |
|
symptoms |
<= 9 days |
+1 |
|
|
> 9 days |
-3 |
|
history previous UTI |
present |
+2 |
|
|
absent |
-1 |
|
history of previous IVP |
present |
+2 |
|
|
absent |
0 |
|
protein in urine |
present |
+5 |
|
|
absent |
-2 |
|
blood in urine |
present |
+4 |
|
|
absent |
-1 |
|
nitrites in urine |
present |
+4 |
|
|
absent |
-1 |
after Table 3, page 103
|
Parameter for Women 15-49 Years Old |
Finding |
Points |
|---|---|---|
|
frequency |
present |
+1 |
|
|
absent |
-3 |
|
nocturia |
present |
+2 |
|
|
absent |
-2 |
|
dysuria |
present |
+2 |
|
|
absent |
-2 |
|
urgency |
present |
+1 |
|
|
absent |
-1 |
|
hematuria |
present |
+3 |
|
|
absent |
0 |
|
offensive smelling urine |
present |
+2 |
|
|
absent |
0 |
|
nausea |
present |
-2 |
|
|
absent |
0 |
|
symptoms |
<= 9 days |
+1 |
|
|
> 9 days |
-3 |
|
history previous UTI |
present |
0 |
|
|
absent |
0 |
|
history of previous IVP |
present |
+2 |
|
|
absent |
0 |
|
protein in urine |
present |
+3 |
|
|
absent |
-1 |
|
blood in urine |
present |
+3 |
|
|
absent |
-3 |
|
nitrites in urine |
present |
+11 |
|
|
absent |
-2 |
|
Parameters for Women >= 50 Years Old |
Finding |
Points |
|---|---|---|
|
frequency |
present |
+1 |
|
|
absent |
-3 |
|
nocturia |
present |
+2 |
|
|
absent |
-4 |
|
dysuria |
present |
+2 |
|
|
absent |
-2 |
|
urgency |
present |
+1 |
|
|
absent |
-1 |
|
hematuria |
present |
0 |
|
|
absent |
0 |
|
offensive smelling urine |
present |
+2 |
|
|
absent |
-1 |
|
nausea |
present |
-2 |
|
|
absent |
0 |
|
symptoms |
<= 9 days |
0 |
|
|
> 9 days |
0 |
|
history previous UTI |
present |
+1 |
|
|
absent |
-2 |
|
history of previous IVP |
present |
+2 |
|
|
absent |
0 |
|
protein in urine |
present |
0 |
|
|
absent |
0 |
|
blood in urine |
present |
+1 |
|
|
absent |
-2 |
|
nitrites in urine |
present |
+5 |
|
|
absent |
-2 |
SHU score =
= SUM(points for all of the parameters)
Interpretation:
• A score of 0 corresponds to a probability of infection of 50%.
• The lowest score appears to be –19.
• The highest score can be > 20 but at this point the probability of infection is > 99.9%.
|
Score |
Odds |
|---|---|
|
0 |
1 to 1 (50%) |
|
+1 to +4 |
(SHU score) to 1 |
|
> +4 |
2^((SHU score)/2) to 1 |
|
-4 to –1 |
ABS((SHU score)) to 1 against |
|
< -4 |
2^((ABS(SHU score))/2) to 1 against |
based on Appendix 1, page 104
where:
• ABS = absolute value
• percent probability = (odds) / ((odds) + 1) * 100%
• percent probability with odds against = 1 / ((odds for ABS(SHU)) + 1) * 100%
|
Score |
Odds |
Score |
Odds |
|---|---|---|---|
|
+1 |
1.41 to 1, or 59% |
-1 |
1.41 to 1 against, or 41% |
|
+2 |
2 to 1 for, or 66% |
-2 |
2 to 1 against, or 33% |
|
+3 |
3 to 1 for, or 75% |
-3 |
3 to 1 against, or 25% |
|
+4 |
4 to 1 for, or 80% |
-4 |
4 to 1 against, or 20% |
|
+5 |
5.66 to 1, or 85% |
-5 |
5.66 to 1 against, or 15% |
|
+6 |
8 to 1, or 89% |
-6 |
8 to1 against, or 11% |
|
+7 |
11.3 to 1, or 92% |
-7 |
11.3 to 1 against, or 8% |
|
+8 |
16 to 1, or 94% |
-8 |
16 to 1 against, or 6% |
|
+9 |
22.6 to 1, or 95.8% |
-9 |
22.6 to 1 against, or 4.2% |
|
+10 |
32 to 1, or 97% |
-10 |
32 to 1 against, or 3% |
|
+11 |
45.25 to 1, or 97.8% |
-11 |
42.25 to 1 against, or 2.2% |
|
+12 |
64 to 1, or 98.5% |
-12 |
64 to 1 against, or 1.5% |
|
+13 |
90.5 to 1, or 98.9% |
-13 |
90.5 to 1 against, or 1.1% |
|
+14 |
128 to 1, or 99.2% |
-14 |
128 to 1 against, or 0.8% |
|
+15 |
181 to 1, or 99.5% |
-15 |
181 to 1 against, or 0.5% |
|
+16 |
256 to 1, or 99.6% |
-16 |
256 to 1 against, or 0.4% |
|
+17 |
362 to 1, or 99.7% |
-17 |
362 to 1 against, or 0.3% |
|
+18 |
512 to 1, or 99.8% |
-18 |
512 to 1 against, or 0.2% |
|
+19 |
724 to 1, or 99.9% |
-19 |
724 to 1 against, or 0.1% |
Specialty: Infectious Diseases, Urology
ICD-10: ,
