Urinary tract infections in young children: High guideline adherence of triage nurses at general practice co-operatives

Mirjam Harmsen, Paul H J Giesen, Johannes C. van der Wouden, Richard P T M Grol, Michel Wensing

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Background: Urinary tract infection (UTI) is one of the most common bacterial infections among children, and it can have serious consequences including renal failure. Triage nurses at general practice (GP) co-operatives play an important role in identifying UTI in young children, but diagnosis is difficult because the symptoms tend to be non-specific. Aim: The aim of this study was to determine what triage nurses at GP co-operatives do when UTI in a child is suspected, or when a feverish child is presented. Methods: A survey study of triage nurses at Dutch GP co-operatives based on four vignettes was carried out. The information in the vignettes consisted of data about one 5-year-old child with suspected UTI, and three children with fever without focus (a 14-month-old boy with a 3-day fever, a 2-month-old girl with a 2-day fever, and a 4-year-old child with a 5-day fever). Results: A total of 145 questionnaires (59% response rate) were returned. If UTI was suspected, all triage nurses requested the parents to provide a sample of the child's urine, but only 70% gave instructions on how to collect the urine. More than 90% of the triage nurses requested the feverish children aged 2 months and 4 years to appear at the GP co-operative. Eighty per cent also requested the 14-month-old boy with fever without focus to appear, even though there was no direct need for this request. In most cases, the triage nurses did not think UTI was likely, mainly because they thought another focus was more likely. Discussion: More than 90% of triage nurses at GP co-operatives acted according to the guidelines if UTI was suspected. Even though UTI was not the first focus a triage nurse thought of when a child with fever without focus was presented, she requested the child to be brought to the GP co-operative almost every time. Possible interventions to improve the detection of children's UTIs could focus on the importance of the timeliness of detection, while over-diagnosis should be prevented.

Original languageEnglish
Pages (from-to)241-247
Number of pages7
JournalQuality in primary care
Issue number4
Publication statusPublished - 1 Dec 2005


  • Child
  • GP co-operative
  • Primary health care
  • Quality of health care
  • Urinary tract infections

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