Current gastroenterology

Abstract

<h3>Background</h3> Our Paediatric Emergency Department (ED) follows a local, multi-specialty designed guideline for the investigation of Urinary Tract Infection (UTI). All children and young people (CYP) presenting with a first proven, or otherwise previously uninvestigated, UTI undergo routine outpatient urinary tract ultrasound (US) imaging. This pathway deviates from National Institute for Health and Care Excellence (NICE) guidance which recommends that children over six months old only undergo imaging if their UTI is atypical or recurrent. The primary aim of this project was to establish the proportion of those undergoing imaging who had a urinary tract abnormality (pre-existing or resultant) requiring specialist referral. We then appraised whether the yield from our investigation pathway justified deviation from NICE guidance. <h3>Method</h3> A retrospective service evaluation was conducted for the period 1 May 2016 to 30 April 2019. Inclusion criteria: all ED-requested US for patients aged 6 months and over with a documented first proven or previously uninvestigated UTI. Exclusion criteria: CYP under six months old; duplicate requests; previous US for UTI; pre-existing UTI follow-up; known pre-existing nephro-urological condition; US indication unrelated to UTI. Patients were identified using the Trust radiology system, with a review of the ED documentation and radiology reports. Reported abnormalities were reviewed against our guideline’s agreed criteria for specialist referral, to determine if follow-up planning was appropriate. <h3>Results</h3> 358 Urinary Tract US were requested during the study period, 161 of which were requested in line with the local UTI guideline. 5 (3.1%) US were not attended but were included in an intention to investigate analysis. 35 (21.7%) patients had nephro-urological abnormalities identified that were referred for general paediatric, urology or nephrology follow-up. An additional 15 (9.3%) patients had US findings that may also have warranted nephro-urological follow-up, giving a potential 50 (31.1%) patients with abnormalities detected outside of NICE guidance. <h3>Conclusion</h3> Up to 31% of patients investigated with US during the three year study period had an abnormality detected that would have remained unidentified if practicing within NICE guidance. Routine US offers a non-invasive, low-risk, low-cost investigative tool to identify nephro-urological abnormalities earlier, improving safety and quality of patient care.