Development of renal scars in children: missed opportunities in management. South Bedfordshire Practitioners' Group.

Abstract

To assess the antecedent medical care of children with renal scars. Retrospective study of both general practice and hospital records. 12 Group practices in south Bedfordshire and the radiology and paediatric outpatient departments of a district general hospital. 23 Children with renal scars (six boys, 17 girls) from the 12 group practices, identified from outpatient, radiology, and general practice records. Number of children in whom a diagnosis of urinary tract infection had been made without prior examination of a mid-stream specimen of urine; number of children who had had a confirmed urinary tract infection that had not been investigated further; number who had experienced delays in investigation or referral; and number who had received inadequate follow up. In all, 11 of the children had received suboptimal medical care, but the management of the other 12 could not have been better. The most common error was failure to investigate possible urinary tract infections, but follow up of confirmed infections was also inadequate. These problems occurred in hospital as well as in general practice. Opportunities for intervention had been missed in nearly half of this sample of children with renal scars.