DUTY

The DUTY (Diagnosis of Urinary Tract infection in Young children) study was designed to improve the way in which doctors and nurses find out when a young child has a urine infection so that they can start effective treatment earlier.

Summary

A total of 7,163 children under 5 years old, who were visiting their general practitioner (GP) or a similar NHS service, joined the DUTY study. All were unwell or had urine symptoms.

During the study we collected details about the child’s illness and their general health as well as a urine sample. We preferred the urine sample to be collected by a ‘clean catch’ (straight from the child into a urine container), but where this was not possible we used a ‘nappy pad’ (a clean towel put into the child’s nappy after cleaning their bottom).

Once we had the urine, we did a simple test (urine dipstick) at the GP practice. After that, it was sent to a research laboratory to see if there was an infection.

Results

We looked to see if any parent-reported symptoms or doctor-/nurse-reported examination findings or the dipstick test results made a urine infection more likely. We found that they did, especially when children were able to provide a ‘clean-catch’ sample.

These urine infections were more likely when their parents said that children:

• had pain/crying when they passed urine
• had smelly urine
• had had a previous urine infection and
• did not have a severe cough.

Urine infections were also more likely:

• when the doctor/nurse thought that the child was more unwell, and
• when the dipstick test was positive.

Related publications

• Downing, H. et al., 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 (1) 158. (10.1186/1471-2334-12-158)
• Hay, A. D. , Whiting, P. and Butler, C. C. 2011. How best to diagnose urinary tract infection in preschool children in primary care?. British Medical Journal (BMJ) 343 (d6316), pp.903-905. (10.1136/bmj.d6316)