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Unexplained extra visits to general practitioners before the diagnosis of first urinary tract infection: a
J H Van Der Voort1, A G Edwards, R Roberts
1KRUF Children's Kidney Centre, University Hospital of Wales, Cardiff CF14 4XW, UK. jhvandervoort@hotmail.com
Insights
Children diagnosed with urinary tract infections (UTIs) visited their general practitioners (GPs) more often before diagnosis, with increased infectious illness visits and antibiotic prescriptions. Renal scarring did not alter this pattern, suggesting other factors in scar development.
Area of Science:
- Pediatrics
- Infectious Diseases
- Nephrology
Background:
- Urinary tract infections (UTIs) are common in children.
- Renal scarring can result from UTIs and lead to long-term kidney damage.
- Early identification of UTI risk factors is crucial for timely diagnosis and management.
Purpose of the Study:
- To compare the frequency of general practitioner (GP) visits before a confirmed diagnosis in children with a first UTI versus those without.
- To investigate if children with renal scarring at first UTI diagnosis had more pre-diagnosis GP visits compared to those without scarring.
Main Methods:
- A case-control study involving 77 children with a first UTI (37 with renal scarring, 40 without) and 77 matched controls.
- Analysis of general practice records for illness types, antibiotic prescriptions, and urine sample requests prior to the first UTI diagnosis or equivalent period.
Main Results:
- Children with a first UTI had 21% more GP visits (2.94 additional visits) in the 2.4 years prior to diagnosis, including 23% more for infectious illness.
- Cases had significantly more genitourinary symptom visits, febrile visits, antibiotic prescriptions, and urine samples requested compared to controls.
- Both children with and without renal scarring showed similar excess GP visit rates before UTI diagnosis.
Conclusions:
- Children diagnosed with a first UTI exhibit a higher frequency of GP visits and antibiotic prescriptions before diagnosis, potentially indicating undiagnosed UTIs.
- The similar excess visit rates in children with and without renal scarring suggest other etiological factors contribute to scar formation.
- Increased pre-diagnosis healthcare utilization highlights opportunities for earlier UTI detection in pediatric populations.
Aims:
To determine: (1) whether children diagnosed with a urinary tract infection (UTI) visited their general practitioner (GP) more frequently before the diagnosis of UTI was established compared to children never diagnosed with a UTI; and (2) whether those children with evidence of renal scarring at their first diagnosed UTI visited their GPs more frequently before diagnosis compared to children who did not have evidence of renal scarring when their first UTI was investigated.
Methods:
Case-control study of 77 children with a UTI identified from a hospital radiology database (37 with and 40 without renal scarring), and 77 age, sex, and general practice matched controls. Main outcome measures were entries in general practice clinical records for types of illness, antibiotic prescriptions, and urine samples requested prior to the diagnosis of first UTI (cases) or equivalent time periods for controls.
Results:
Cases had a mean 2.94 additional visits or 21% more visits (95% CI 1% to 41%) in the period (mean 2.4 years) prior to the visit at which their first UTI was diagnosed, including a mean 2.5 additional visits or 23% more visits for infectious illness (95% CI 1% to 45%). The cases had 114% (95% CI 41% to 184%) more visits for symptoms relating to the genitourinary tract, though the actual number of these visits was small. They were febrile at 49% more visits (95% CI 1% to 99%) and received significantly more courses of antibiotics than controls (5.2 v 4.1). They had more urine samples requested (37 v 3). Both the cases with and without renal scarring had similar excess GP visits.
Conclusion:
Compared to controls, children diagnosed with a first UTI had more visits at which symptoms of infection were recorded and more antibiotics prescribed prior to the visit at which the first UTI was diagnosed. These excess visits may have included undiagnosed UTIs. Both those with and without renal scarring had a similar degree of excess visits; additional aetiological factors must have played a role in scar formation.
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