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Abstract
Introduction Urinary Tract Infection (UTI) is a common bacterial infection. Natural history in children has changed over the last 30–50 years due to antibiotics and improvements in healthcare. There remains uncertainty about the most appropriate and effective way to manage UTIs in children including whether or not investigations, follow-up and prophylaxis are justified. The correct timeframe during which these should occur depends on presentation and age of the child.
Aims NICE clinical guideline 54 is often confusing due to the complex nature of follow up and the range of investigations required depending on presentation and age. The guideline can be quite challenging to follow in a busy general practice environment. The aim is to assess current management in terms of referral and further investigations and suggest any necessary improvements to facilitate this process.
Method Retrospective audit looking at management of patients under 16 years old presenting to an inner city general practice from September 2010–14 with suspected UTI. Culture positive UTIs were identified and patients who fulfilled the NICE criteria for referral were highlighted. Referrals were categorised as appropriate, inappropriate or missed. Grade of clinician who assessed the patient was also categorised as trainee, GP or locum. Results: n = 15. Overall 13% referrals were appropriate, 33% inappropriate and 53% missed. 100% trainee referrals were inappropriate, 80% GP referrals were missed and 50% locum referrals were inappropriate. There was confusion about whether to refer to paediatric urology or paediatrics (40% and 30% respectively). 88% missed referrals related to atypical UTIs.
Conclusion NICE clinical guideline 54 is not easy to follow in a time pressured environment. This is evident across all grades of clinician. It was noted that patients presenting to out-of-hours or A&E often do not have a urine sample sent for culture, hindering decisions regarding referral and further investigation. There was confusion about whether to refer to paediatrics or paediatric urology. Atypical UTIs were most likely to be mis-managed. An intuitive UTI flowchart has therefore been designed to facilitate easier identification of children who require tertiary referral and hence improve management.
