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Guidelines to identify abnormalities after childhood urinary tract infections: a prospective audit
  1. Malcolm G Coulthard1,
  2. Heather J Lambert1,
  3. Susan J Vernon1,
  4. Elizabeth W Hunter2,
  5. Michael J Keir3
  1. 1Paediatric Nephrology Unit, Great North Children's Hospital, Newcastle, UK
  2. 2Department of Paediatric Radiology, Great North Children's Hospital, Newcastle, UK
  3. 3Department of Medical Physics, Great North Children's Hospital, Newcastle, UK
  1. Correspondence to Dr Malcolm G Coulthard, South Park House, South Park, Hexham, Northumberland NE46 1BS; malcolm.coulthard{at}nuth.nhs.uk

Abstract

Objective To compare the childhood urinary tract infection (UTI) guidelines from the Royal College of Physicians (RCP) in 1991 and from National Institute of Health and Care Excellence (NICE) (CG54) in 2007 by measuring their efficiency at detecting urinary tract abnormalities.

Design Children with UTIs within the Newcastle Primary Care Trust (population 70 800 children) were referred and imaged according to the RCP guidelines during 2008, and these were compared to the activity that would have been undertaken if we had implemented the CG54 guidelines, including following them through 2011 to identify those with recurrent UTIs.

Main outcome measures The numbers of children imaged, the imaging burden and efficiency, and urinary tract abnormalities detected by each guideline.

Results Fewer children would have been imaged by CG54 than RCP (150 vs 427), but its sensitivity was lower, at 44% for detecting scarring, 10% for identifying vesicoureteric reflux and 40% for other abnormalities. Overall, it would have only detected one-quarter of the abnormal cases (8 vs 32) and would have missed five of nine children with scarring, including three with multiple lesions and one with renal impairment. Imposing an age restriction of <8 years to the RCP guidelines would reduce its screening rate by 20% and still detect 90% of the abnormalities.

Interpretation The CG54 guidelines do not alter the imaging efficiency compared to the RCP guidelines, but they are considerably less sensitive.

  • urinary tract infection
  • vesicoureteric reflux
  • renal scarring
  • urinary tract imaging

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/

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