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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

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
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
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/design: 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???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 >103, but usually >105 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
1471-2334
158
Downing, Harriet
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Thomas-Jones, Emma
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Gal, Micaela
2d266726-f171-4a55-a381-29c5a2e42ec1
Waldron, Cherry-Ann
74f893bb-7b67-4f67-b598-7d598cfd4085
Sterne, Jonathan
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Hollingworth, William
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Hood, Kerenza
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Delaney, Brendan
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Little, Paul
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Howe, Robin
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Wootton, Mandy
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Macgowan, Alastair
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Butler, Christopher C.
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Hay, Alastair D.
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DUTY Study Team
Downing, Harriet
6f9fc478-f778-4eae-b5ef-f4d3430d59db
Thomas-Jones, Emma
ea15d5ac-8232-4823-ab40-17bec0968520
Gal, Micaela
2d266726-f171-4a55-a381-29c5a2e42ec1
Waldron, Cherry-Ann
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Sterne, Jonathan
05fbcb78-68a6-4461-815e-e1f555602bd5
Hollingworth, William
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Hood, Kerenza
62906d76-4931-4b12-9a64-0c867c7b84c1
Delaney, Brendan
faccda65-7adf-4e79-b97a-b79814a016fd
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Howe, Robin
e02d3c72-421b-4396-bf99-392e8847247f
Wootton, Mandy
d0cbb02c-9039-42f8-98d1-62d741bd42e5
Macgowan, Alastair
6989ea1c-bf33-4210-b79e-891a1193d69d
Butler, Christopher C.
2782a915-eb8d-48bb-ae70-118114697f57
Hay, Alastair D.
bfae9e44-ae9b-473c-923f-1dea50747023

Downing, Harriet, Thomas-Jones, Emma, Gal, Micaela, Waldron, Cherry-Ann, Sterne, Jonathan, Hollingworth, William, Hood, Kerenza, Delaney, Brendan, Little, Paul, Howe, Robin, Wootton, Mandy, Macgowan, Alastair, Butler, Christopher C. and Hay, Alastair D. , DUTY Study Team (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 (158), 158. (doi:10.1186/1471-2334-12-158). (PMID:22812651)

Record type: Article

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/design: 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???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 >103, but usually >105 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

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More information

Published date: 2012
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 349994
URI: http://eprints.soton.ac.uk/id/eprint/349994
ISSN: 1471-2334
PURE UUID: fb6f4721-e50f-4480-a9b2-0dd36c226b7b

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Date deposited: 15 Mar 2013 11:11
Last modified: 08 Nov 2021 23:42

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Contributors

Author: Harriet Downing
Author: Emma Thomas-Jones
Author: Micaela Gal
Author: Cherry-Ann Waldron
Author: Jonathan Sterne
Author: William Hollingworth
Author: Kerenza Hood
Author: Brendan Delaney
Author: Paul Little
Author: Robin Howe
Author: Mandy Wootton
Author: Alastair Macgowan
Author: Christopher C. Butler
Author: Alastair D. Hay
Corporate Author: DUTY Study Team

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