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10-02-2013 | General practice | Article

GPs ‘may miss UTI in children’


Free abstract

medwireNews: Doctors should be more alert to the possibility of a urinary tract infection (UTI) in children, argue researchers in the British Journal of General Practice.

Their study suggested that relying on the presence of a fever or lack of an alternative possible infection to determine the need for urinary sampling, as outlined in current guidance, could mean GPs will miss many cases.

In a study of just over 1,000 children from 13 general practices, recruited over a 2-year period, the team found that 5.9% of the 597 children who underwent urinary sampling within 2 days turned out to have a UTI.

The prevalence was higher among those under the age of 3 years, at 7.3%, compared with 3.2% in 3-5-year-olds.

Multivariable analysis revealed that neither a history of fever nor absence of an alternative source of infection was associated with UTI. On the other hand, pain or crying on passing urine, and increased urinary frequency or frequency of wet nappies, were both predictors of UTI.

Based on a 'working diagnosis' recorded by GPs at the initial consultation, urine sampling based on GPs' suspicion would have missed 80% of cases, while basing it on NICE guidelines being applied would have missed 51%.

"The probability of UTI in children under the age of 3 years is reasonably high, irrespective of the presenting symptoms and signs," conclude Dr Kathryn O'Brien (Cardiff University) and team.

"Larger studies are needed, but a lower threshold for urine sampling in young children appears to be indicated."

medwireNews is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Caroline Price, Senior medwireNews Reporter