Nicely does it: are children with urinary tract infections being identified in A&E?

• Published in: Archives of disease in childhood Vol. 96; no. Suppl 1; p. A88
• Main Authors: Thayalan, M, Round, J
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health 01.04.2011; BMJ Publishing Group LTD
• Subjects: Aspiration; Guidelines; Infants; Urine; Young Children
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/adc.2011.212563.205

Aims To investigate if patients under 6 years of age, presenting with symptoms suggestive of a urinary tract infection (UTI), are being correctly identified and managed in accordance with the National Institute of Clinical Excellence (NICE) guidelines1 in paediatric A&E. Methods A retrospective study, over 1 month, of case notes from three A&E departments in a region. Patients selected were 6 years or under and presenting with a medical complaint. A+E records were reviewed for the presentation of common UTI symptoms as listed in NICE UTI guidelines. Information regarding the information of infection and first-stage management was collated. Specific audit points were adapted from the NICE criteria. Results A total of 2220 records were identified and all records reviewed. 236 children presented with unexplained fever of 380°C or higher. All should have had a urine sample tested within 24 h, but only 34% had this documented in the A+E records. The 1122 children who presented with common symptoms or signs of UTI should have had a urine sample tested for infection. However only 49% of children presenting with 4 common signs or symptoms of UTI and 82% presenting with five or more symptoms actually had a urine sample tested at all. 61 infants under 3 months were identified. All should have had their urine samples sent for urgent microscopy and culture, however, just 18% of infants were managed in this way. All urine samples taken for children 3 years or older (n=134) were tested using dipstick for leucocyte esterase and nitrite as the first-stage strategy, as recommended in guidance. 1 record of suprapubic aspiration was recorded. NICE guidelines recommend ultrasound prior to the SPA to demonstrate the presence of urine in the bladder, but this was not followed. The aspiration was not successful. Conclusions This study demonstrates poor compliance to the NICE guidelines in the identification and first-stage management of UTIs in several paediatric A&Es. This raises issues with training and buy-in to these guidelines by A+E staff.