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The waiting game

NICE guidance on childhood urinary infections questioned

By Lilian Anekwe

NICE guidance on children's urinary tract infections may lead to incorrect diagnosis in as many as 40% of cases, a new study suggests.

Diagnosing children without access to microscopy can lead to many being inappropriately treated and other cases being missed, with ‘serious implications' for management, the researchers warned.

NICE guidance on the management of childhood UTI, published in August 2007, recommended infants and children with unexplained fever of 38°C or higher should have a dipstick test within 24 hours if microscopy was not available.

Researchers retrospectively applied the guidance to 209 children's case notes and examined data on dipstick, microscopy and laboratory culture results. They found the initial diagnoses of UTI were incorrect in nearly 40% of cases and that 15% of cases would have been missed if microscopy had not been carried out – figures they described as ‘concerning'.

Study leader Dr Markus Hesseling, paediatric consultant at Glan Clwyd hospital in Rhyl, Flintshire, said: ‘We recommend caution and flexibility in use of the NICE guideline to avoid underdiagnosis and overdiagnosis of UTIs in children.'

The research was presented at the Royal College of Paediatrics and Child Health's spring conference in York last week.

A NICE spokesperson said: 'All NICE clinical guidelines are reviewed periodically following publication, to see if new evidence is available which may require the recommendations to be reconsidered. The expected review of this guidance is planned for summer 2010.'

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