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To the Editor: In their Rational Clinical Examination article, Dr Bent and colleagues¹ evaluated the accuracy and precision of the clinical history and examination for the diagnosis of urinary tract infection (UTI). Clinicians often rely on a single symptom or sign to establish the diagnosis,² so it is important that they be aware of the pretest probability. However, the pretest probability of infection that Bent et al cite (48%) seems very high to us. One of us (T.F.) has calculated a 25% to 29% pretest probability of UTI in patients attending 8 primary care practices in the United Kingdom.² We are also aware of another study that found a pretest probability of 35%.³ We therefore reexamined the studies that Bent et al used, added the study by Dobbs and Fleming,³ and performed a meta-analysis on only those articles that exclusively studied women with symptoms suggestive of UTI.^4-6 We excluded studies . . . [Full Text of this Article]

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