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A nurse led education and direct access service for the management of urinary tract infections in children: Prospective controlled trial

Lookup NU author(s): Dr Malcolm Coulthard, Dr Sue Vernon, Dr Heather Lambert, Professor John MatthewsORCiD



Objectives: To determine whether a nurse led education and direct access service improves the care of children with urinary tract infections. Design: Prospective cluster randomised trial. Setting: General practitioners in the catchment area of a UK paediatric nephrology department. Participants: 88 general practices (346 general practitioners, 107 000 children). Main outcome measures: Rate and quality of diagnosis of urinary tract infection, use of prophylactic antibiotics, convenience for families, and the number of infants with vesicoureteric reflux in whom renal scarring may have been prevented. Results: The study practices diagnosed twice as many urinary tract infections as the control practices (6.42 v 3.45/1000 children/year; ratio 1.86, 95% confidence interval 1.42 to 2.44); nearly four times more in infants (age > 1 year) and six times more in children without specific symptoms. Diagnoses were made more robustly by study practices than by control practices; 99% v 89% of referred patients had their urine cultured and 79% v 60% had bacteriologically proved urinary tract infections (P < 0.001 for both). Overall, 294 of 312 (94%) children aged under 4 years were prescribed antibiotic prophylaxis by study doctors compared with 61 of 147 (41%) by control doctors (P < 0.001). Study families visited hospital half as much as the control families. Twice as many renal scars were identified in patients attending the study practices. Twelve study infants but no control infants had reflux without scarring. Conclusion: A nurse led intervention improved the management of urinary tract infections in children, was valued by doctors and parents, and may have prevented some renal scarring.

Publication metadata

Author(s): Coulthard MG, Vernon SJ, Lambert HJ, Matthews JNS

Publication type: Article

Publication status: Published

Journal: British Medical Journal

Year: 2003

Volume: 327

Issue: 7416

Pages: 656-659

Print publication date: 20/09/2003

Date deposited: 15/10/2010

ISSN (print): 0959-8138

ISSN (electronic): 1756-1833

Publisher: BMJ Group


DOI: 10.1136/bmj.327.7416.656

PubMed id: 14500439


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