Background To improve reliable diagnosing UTI in young, non-toilet trained children, a diagnostic strategy of the Nice guideline was nationally introduced in the Netherlands. This study aims to determine the impact of this new diagnostic strategy in clinical practice. We evaluated determinants of successful implementation.
Methods We conducted a cross-sectional observational study, with observations before and after implementation. We prospectively collected data from healthy children aged 1 month- 2 years, presenting with fever at the emergency room at Sophia Children’s Hospital in 2008 and 2010–2011. Primary outcome measure: assessment of children suspected with UTI according to the guideline and determinants of implementation. Secondary outcomes: number of contaminated cultures, hospitalisation and antibiotic treatment. Outcome measures are assessed by mean (95%CI). Differences before and after implementation were tested using Chi-squared test. Effects of determinants were evaluated using regression analysis.
Results The preintervention group consisted of 207 children (male 64.3%, median age 0.98 years (interquartile range IQR0.77), the postintervention group 194 children (male 55.2%, median age 1.06 year (IQR0.78). Correctly diagnosed UTI increased from 41 (19.8%; 95% CI:14.3–25.3) in the the preintervention group to 101 (52.1%; 95%CI:45.0–59.2) in the postintervention group(p-value< 0.0001). Doctor’s experience, shift or triage urgency did not influence compliance to the guideline. Secondary outcome measures did not significantly differ between the pre- and post-intervention group.
Conclusion Implementation of the guideline has lead to a significant higher frequency of correct assessment of UTI in young children. We could not identify determinants at patient, process or professional level with significant influence on successful implementation.