Downing, Harriet, Thomas-Jones, Emma, Gal, Micaela  ORCID: https://orcid.org/0000-0002-1326-190X, Waldron, Cherry-Ann ORCID: https://orcid.org/0000-0001-8465-2492, Sterne, Jonathan, Hollingworth, William, Hood, Kerenza ORCID: https://orcid.org/0000-0002-5268-8631, Delaney, Brendan, Little, Paul, Howe, Robin A., Wootton, Mandy, MacGowan, Alastair, Butler, Christopher Collett ORCID: https://orcid.org/0000-0002-0102-3453 and Hay, Alastair D.
2012.
The diagnosis of urinary tract infections in young children (DUTY): Protocol for a diagnostic and prospective observational study to derive and validate a clinical algorithm for the diagnosis of UTI in children presenting to primary care with an acute illness.
BMC Infectious Diseases
12
(1)
, 158.
10.1186/1471-2334-12-158
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Abstract
Background: Urinary tract infection (UTI) is common in children, and may cause serious illness and recurrent symptoms. However, obtaining a urine sample from young children in primary care is challenging and not feasible for large numbers. Evidence regarding the predictive value of symptoms, signs and urinalysis for UTI in young children is urgently needed to help primary care clinicians better identify children who should be investigated for UTI. This paper describes the protocol for the Diagnosis of Urinary Tract infection in Young children (DUTY) study. The overall study aim is to derive and validate a cost-effective clinical algorithm for the diagnosis of UTI in children presenting to primary care acutely unwell. Methods: DUTY is a multicentre, diagnostic and prospective observational study aiming to recruit at least 7,000 children aged before their fifth birthday, being assessed in primary care for any acute, non-traumatic, illness of [less than or equal to] 28 days duration. Urine samples will be obtained from eligible consented children, and data collected on medical history and presenting symptoms and signs. Urine samples will be dipstick tested in general practice and sent for microbiological analysis. All children with culture positive urines and a random sample of children with urine culture results in other, non-positive categories will be followed up to record symptom duration and healthcare resource use. A diagnostic algorithm will be constructed and validated and an economic evaluation conducted. The primary outcome will be a validated diagnostic algorithm using a reference standard of a pure/predominant growth of at least >10[3], but usually >10[5] CFU/mL of one, but no more than two uropathogens. We will use logistic regression to identify the clinical predictors (i.e. demographic, medical history, presenting signs and symptoms and urine dipstick analysis results) most strongly associated with a positive urine culture result. We will then use economic evaluation to compare the cost effectiveness of the candidate prediction rules. Discussion: This study will provide novel, clinically important information on the diagnostic features of childhood UTI and the cost effectiveness of a validated prediction rule, to help primary care clinicians improve the efficiency of their diagnostic strategy for UTI in young children.
| Item Type: | Article |
|---|---|
| Date Type: | Publication |
| Status: | Published |
| Schools: | Medicine Systems Immunity Research Institute (SIURI) |
| Subjects: | R Medicine > RC Internal medicine R Medicine > RJ Pediatrics |
| Additional Information: | Pdf uploaded in accordance with publisher's policy at http://www.sherpa.ac.uk/romeo/issn/1471-2334/ (accessed 25/02/2014) |
| Publisher: | BioMed Central |
| ISSN: | 1471-2334 |
| Date of First Compliant Deposit: | 30 March 2016 |
| Last Modified: | 24 May 2023 18:19 |
| URI: | https://orca.cardiff.ac.uk/id/eprint/42865 |
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