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Urinary tract infections in young children: high guideline adherence of triage nurses at general practice co-operatives

Michel Wensing, Richard PTM Grol, Mirjam Harmsen, Paul HJ Giesen, Johannes C van der Wouden

Background Urinary tract infection (UTI) is one of the most common bacterial infections among children, and it can have serious consequences including renal failure. Triage nurses at general practice (GP) co-operatives play an important role in identifyingUTI in young children, but diagnosis is difficult because the symptoms tend to be nonspecific.Aim The aim of this study was to determine what triage nurses at GP co-operatives do when UTI in a child is suspected, or when a feverish child is presented.Methods A survey study of triage nurses at Dutch GP co-operatives based on four vignettes was carried out. The information in the vignettes consisted of data about one 5-year-old child with suspected UTI, and three children with fever without focus (a14-month-old boy with a 3-day fever, a 2-monthold girl with a 2-day fever, and a 4-year-old child with a 5-day fever).Results Atotal of 145 questionnaires (59% response rate) were returned. If UTI was suspected, all triage nurses requested the parents to provide a sample of the child’s urine, but only 70% gave instructions on how to collect the urine. More than 90% of thetriage nurses requested the feverish children aged 2 months and 4 years to appear at the GP cooperative. Eighty per cent also requested the 14-month-old boy with fever without focus to appear, even though there was no direct need for this request. In most cases, the triage nurses did not think UTI was likely, mainly because they thought another focus was more likely.Discussion More than 90% of triage nurses at GP co-operatives acted according to the guidelines if UTI was suspected. Even though UTI was not the first focus a triage nurse thought of when a child with fever without focus was presented, she requestedthe child to be brought to the GP co-operative almost every time. Possible interventions to improve the detection of children’s UTIs could focus on the importance of the timeliness of detection, while over-diagnosis should be prevented.