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How general practitioners manage children with urinary tract infection: an audit in the former Northern Region
S Vernon1, C K Foo, M G Coulthard
1Department of Child Health, University of Newcastle, Newcastle upon Tyne.
Insights
General practitioners (GPs) show varied approaches to managing childhood urinary tract infections (UTIs), with inconsistent diagnostic and treatment practices observed, particularly between weekdays and weekends. Over half of GPs desire enhanced training for effective UTI management in pediatric patients.
Area of Science:
- Pediatrics
- General Practice
- Infectious Disease Management
Background:
- Childhood urinary tract infections (UTIs) are common but challenging to diagnose due to non-specific symptoms and difficulties in urine collection.
- Prompt and accurate management of pediatric UTIs is crucial to prevent permanent renal scarring in young children.
Purpose of the Study:
- To investigate the current management strategies employed by general practitioners (GPs) for children presenting with suspected urinary tract infections (UTIs).
- To identify perceived training needs among GPs regarding the diagnosis and management of pediatric UTIs.
Main Methods:
- A postal questionnaire survey was distributed to 494 general practitioners (GPs) in the former Northern Region.
- The survey assessed GPs' approaches to managing suspected UTIs in children, including diagnostic methods, treatment protocols, and referral practices.
- GPs' perceptions of their training requirements in pediatric UTI management were also evaluated.
Main Results:
- Significant variability exists in UTI diagnostic and treatment practices among GPs, with notable differences between weekday and weekend care.
- Challenges in urine collection were reported, particularly in older children, impacting diagnostic accuracy.
- While most GPs culture urine, a subset relies solely on dipstick tests, and some initiate antibiotic treatment before culture results are available.
- Referral patterns for diagnostic imaging varied by age and sex, with a general desire for further training expressed by over half of the respondents.
Conclusions:
- Wide variations in clinical practice highlight a need for standardized management of pediatric UTIs among general practitioners.
- The development and implementation of clear, collaborative guidelines between pediatricians and GPs, supported by educational initiatives, could improve consistency and quality of care.
- Addressing training needs and standardizing diagnostic and treatment protocols are essential for optimizing outcomes in children with UTIs.
Background:
Urinary tract infections (UTIs) in childhood are common and may be difficult to diagnose because of non-specific symptoms and technical problems with urine collection. Active management is important because UTIs may cause permanent renal scarring in young children.
Aim:
To determine how general practitioners (GPs) manage children with suspected UTIs.
Method:
A postal questionnaire to 494 GPs in the former Northern Region (a random selection of 26.2%) asking how they manage children with suspected UTI and their perception of their training needs.
Results:
A total of 333 (67.4%) GPs replied. On weekdays, up to 22.9% of GPs treated children who had symptoms suggestive of UTI without collecting a diagnostic urine sample, and up to 64.8% did so at weekends. Urine collection was satisfactory in 73.2% of boys and girls aged under one year, but in only 50.4% of older boys and 48.0% of older girls, caused in part by the use of unreliably 'cleaned' potties in the older group. On weekdays, up to 87.2% of GPs culture the urine, but up to 4.8% use dipsticks as the sole diagnostic test; at weekends, only up to 58.6% culture urines, and up to 19.1% rely on dipsticks alone. Up to 11.0% of GPs examine urine under a microscope for bacteria to test for UTI on weekdays and at weekends. Up to 23.8% of GPs who collect urines on weekdays wait for a positive culture result before starting antibiotics. At weekends, only 3.9% of GPs build in this delay to treatment, mainly because far fewer take urine samples at all. GPs refer younger children for diagnostic imaging more readily than older ones, and boys more readily than girls at all ages. Although virtually all GPs refer all children under five years, some still do so only after recurrent infections. Over half the GPs wanted more training in managing UTI in children.
Conclusion:
There is a wide variation in clinical practice by GPs. Some always appropriately collect and test urine samples, treat without delay and refer for imaging after one proven UTI. Some never collect urines, treat blindly and refer only young infants with recurrent UTIs. Many vary their standards of practice from weekdays to weekends. The provision for GPs of clear, local, practical guidelines, drawn up between paediatricians and GPs and backed up with study days, might produce a consistent improvement in standards.