Will the implementation of the 2007 National Institute for Health and Clinical Excellence (NICE) guidelines on childhood urinary tract infection (UTI) in the UK miss significant urinary tract pathology?

Abstract

• To investigate whether the implementation of the August 2007 National Institute for Health and Clinical Excellence (NICE) guidelines would miss significant urinary tract pathology in children with urinary tract infection (UTI). • All ultrasound (US) performed in children aged >6 months, during the year 1 August 2006 to 31 July 2007 for UTI, were retrospectively studied. • Each US scan in the study population of 346 was categorised dependent on whether it was appropriate or inappropriate to have been performed under the new guidelines and whether the US scan was normal or abnormal. • The records of each patient with an inappropriate abnormal US scan were re-analysed to see if patient management was affected by the US scan. • In 2011 patients with an original inappropriate abnormal US scan were re-evaluated to identify if any had presented with further urinary pathology. • In accordance with the NICE guidelines patients were divided by age. • Children aged 0.5-3 years: 78/95 (82%) US scans were inappropriate of which 12 (15%) were abnormal and four of these had a further documented UTI. After careful assessment of the US abnormalities it was judged that only one would have benefited from the initial US scan. • Children aged >3 years: 146/251 (58%) US scans were inappropriate of which 21(14%) were abnormal and six of these (29%) had a further documented UTI. After careful assessment of the US abnormalities it was judged that only three of 21 (14%) would have benefited from the initial US scan. • The vast majority of anomalies detected on the inappropriate US scans were of little clinical significance. • It is difficult to identify any patient who would have been truly disadvantaged if the US scan had not been performed after the initial UTI. • The NICE guidelines are safe to follow.