Imaging the renal tract in under 16s with Urinary Tract Infection (UTI).
Descriptor
NICE guidelines for managing UTI in under 16 years were published in August 2007 and recently updated in September 2017. The aim of this audit is to assess compliance with them. This audit is also valuable in identifying patients having unnecessary investigations.
Background
The new NICE guidelines for managing UTI in under 16s aim to “achieve more consistent clinical practice, based on accurate diagnosis and effective management”. Avoiding unnecessary imaging tests alleviates anxiety for children and parents, in addition to reducing costs.
The Cycle
The standard:
Imaging in under 16s who have suffered a UTI should be performed according to the tables taken directly from the NICE Guidelines which can be accessed via https://www.nice.org.uk/guidance/cg54/chapter/Recommendations#imaging-tests (Ref. 1).
Target:
100% compliance with NICE guidelines.
Assess local practice
Indicators:
The percentage of USS, DMSA and MCUG requests which contain clinical information justifying the examination according to the NICE guidelines, for each age group.
Data items to be collected:
Review the clinical details on each request form to determine whether or not they comply with the set guidelines for the relevant age group (Ref. 1).
Evaluate if appropriate clinical information has been given. It is also imperative to assess request forms where imaging was not performed.
Suggested number:
50 USS, 25 DMSA, 25 MCUG requests. Prospective or retrospective data may be collected.
Suggestions for change if target not met
The Setpember 2017 NICE guidelines can be found in the resources section and could be circulated to all referrers (GPs, A&E and Paediatricians).
Presentation of findings at audit meeting.
Reiteration of guidelines at local audit meetings.
Re-audit after the above measures have been undertaken.
Resources
Time for Radiologist to
- collect appropriate request cards,
- correlate clinical details with published guidelines and record if compliance is achieved.
CG54 : Urinary tract infection in under 16s: diagnosis and management.
References
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NICE Clinical Guidance 54 (CG54): Urinary tract infection in under 16s: diagnosis and management. Published August 2007. Updated September 2017. https://www.nice.org.uk/guidance/cg54/chapter/Recommendations#imaging-tests
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National Collaborating Centre for Women’s and Children’s Health Urinary tract infection inchildren: diagnosis, treatment and long-term management. London, UK: National Institute forHealth and Clinical Excellence, August 2007. Available at http://www.nice.org.uk/guidance/cg54/evidence/cg54-urinary-tract-infection-in-children-full-guideline2
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Baumer JH, Jones RW. Urinary tract infection in children. National Institute for Health andClinical Excellence. Arch Dis Child Educ Pract Ed. 2007 Dec;92(6):189-92.
Editor’s comments
This audit could be adapted to check if patients with UTI who meet the criteria for tests, actually receive them. This could be done prospectively for A&E, inpatients and outpatients. However would be more challenging for patients who have only seen their GP.
Submitted by
Dr P Patel & Dr S Maheshwaran. Updated by Dr H Bailey 2018