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Long-term outcomes of urinary tract infection (UTI) in Childhood (LUCI): Protocol for an electronic record-linked cohort study

Research output: Contribution to journalArticle

Original languageEnglish
Article numbere024210
Number of pages11
JournalBMJ Open
Volume9
Issue number4
Early online date20 Apr 2019
DOIs
DateAccepted/In press - 8 Feb 2019
DateE-pub ahead of print - 20 Apr 2019
DatePublished (current) - Apr 2019

Abstract

Introduction: Current guidelines advise the prompt diagnosis and treatment of UTI in children to improve both short and longer term outcomes. However, the risk of long-term complications following childhood UTI is unclear. UTI is relatively common but difficult to diagnose in children as symptoms are non-specific. Diagnosis requires a urine sample, but sampling is difficult and infrequent, and it is not clear if sampling should be given greater priority in primary care. The LUCI study will assess the short, medium and longer-term outcomes of childhood UTI associated with routine and systematic sampling practices. Methods and analysis: Two datasets will be established: The first will consist of routinely collected data (Hospital, GP, Microbiology) from children born and resident in Wales, linked via the Secure Anonymised Information Linkage (SAIL) databank (an ‘e-cohort’). Urine sampling in this dataset reflects normal practice ‘routine sampling’. Outcomes (including renal scarring, hypertension, end-stage renal failure(ESRF), hospital admissions, GP consultations, antibiotic prescriptions) for children with at least one UTI confirmed with microbiological culture (mcUTI) or no mcUTI before the age of 5 will be compared. The second will combine data from two prospective observational studies(‘DUTY’ & ‘EURICA’) employing systematic urine sampling for children presenting to primary care with acute, undifferentiated illness, linked to routine data via SAIL (Wales) and NHS Digital (England). Outcomes (as above, plus features of mcUTI) for children with a mcUTI in this dataset, identified through systematic urine sampling, will be compared to those with a mcUTI identified through routine urine sampling (dataset 1). Ethics and dissemination: The study protocol has been approved by NHS Wales Research Ethics Committee and the Health Research Authority’s Confidentiality Advisory Group. Methods of innovative study design and findings will be disseminated through peer-review journals and conferences. Results will be of interest to clinical and policy stakeholders in the UK. Strengths and limitations of this study: • Use of routinely collected data in the study allows the identification of rare chronic outcomes, from large numbers of children at risk. • This multi-sourced dataset will allow a comparison of outcomes over 5 years for children with and without microbiologically confirmed UTI (mcUTI) according to routine clinical practice; and compare outcomes in these groups with those observed in high quality research data using systematic urine sampling. • This study will help to prioritise interventions to improve early diagnosis, sampling and treatment, potentially improving health outcomes and reducing NHS costs. • Using routinely collected data relies on the quality of coding and availability of data. • Using routinely collected data limits the information available on the children and their outcomes.

    Research areas

  • Children, urinary tract infection, medical record linkage, renal scarring, urine sampling, primary care

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    Rights statement: This is the final published version of the article (version of record). It first appeared online via BMJ Publishing at https://bmjopen.bmj.com/content/9/4/e024210 . Please refer to any applicable terms of use of the publisher.

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