EVALUATION OF FEBRILE URINARY TRACT INFECTION CLINICAL PRACTICE GUIDELINES IN THE PEDIATRIC EMERGENCY ROOM.

Abstract

Introduction Urinary tract infections (UTIs) are a common cause of fever and irritability in infants and young children. Multiple UTIs may cause significant renal scarring, possibly resulting in long-term morbidity, including poor somatic growth, chronic renal insufficiency, hypertension, and pregnancy-induced hypertension. Therefore, it is important to make an accurate diagnosis of a UTI and structural renal tract anomalies. Appropriate treatment must include management of the acute infection and possible intervention to prevent further infections. Despite the value of treatment guidelines in patient care, the judgment of a physician can often take precedence. The purpose of this study was to compare current guidelines with emergency physicians9 practices. Methods In January 2005, a UTI Working Group at BC Children9s Hospital (BCCH) implemented the most recent clinical practice guideline for febrile UTIs for children under 2 years of age presenting to the emergency department. A chart review was performed on all children diagnosed with a febrile UTI between January 1, 2005, and December 31, 2005, at BCCH. Data were recorded for all diagnostic tests ordered, the results of each test, what treatment was given, and what follow-up each patient received. Results During 2005, 149 children were diagnosed with a UTI. All patients had a urinalysis and a urine culture performed. A renal sonogram was ordered for 141 of 149 patients (95%), and 129 of 149 patients (87%) received an acute-phase renal cortical scan. In addition, all children received parenteral or oral antibiotics as part of their management. Outpatient therapy was provided for 119 of 149 patients (80%). Conclusions The current UTI clinical practice guideline is being followed by emergency physicians at BCCH. Physician adherence to the current treatment guideline indicates a concordance between emergency physicians9 practices and established standards of care.