BMJ  2003;327:656 (20 September), doi:10.1136/bmj.327.7416.656

Primary care

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

¹ Department of Paediatric Nephrology, Royal Victoria Infirmary, Newcastle NE1 4LP, ² Department of Medical Statistics, University of Newcastle, NE1 7RU

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.

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