ArticleAnnals of family medicine2016
Improving the Diagnosis and Treatment of Urinary Tract Infection in Young Children in Primary Care: Results from the DUTY Prospective Diagnostic Cohort Study.
Article in Annals of family medicine, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03163394 (HD5 Levels in Catheter Versus Bag Urine Specimens in Young Children for the Diagnosis of UTI), which is not on this map. Cited by 17 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
HD5 Levels in Catheter Versus Bag Urine Specimens in Young Children for the Diagnosis of UTI
Who cites it
17 citing papers in PubMed, 54 citations in OpenAlex.
- Urine Testing in Children with Viral Symptoms: A Nationwide Analysis of Ambulatory Visits, 2014-2019.The Journal of pediatrics · 2025Article
- The 2023 Garrod Lecture: Antimicrobial use and stewardship in primary care: what works, and what next?The Journal of antimicrobial chemotherapy · 2025Article
- Assessing children who are acutely ill in general practice using the National PEWS and LqSOFA clinical scores: a retrospective cohort study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2025Article
- Article
- Identifying serious bacterial illness in children: is it time to show the red card to NICE's red flags?The British journal of general practice : the journal of the Royal College of General Practitioners · 2023Article
- Urinary tract infections in children: building a causal model-based decision support tool for diagnosis with domain knowledge and prospective data.BMC medical research methodology · 2022Article
- Accuracy of the NICE traffic light system in children presenting to general practice: a retrospective cohort study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2022Article
- What's the catch? Urine sample collection from young pre-continent children: a qualitative study in primary care.BJGP open · 2020Article
- The impact of physicians' knowledge on outpatient antibiotic use: Evidence from China's county hospitals.Medicine · 2020Article
- Delayed antibiotic prescribing for respiratory tract infections: protocol of an individual patient data meta-analysis.BMJ open · 2019Article
- Development and Validation of a Calculator for Estimating the Probability of Urinary Tract Infection in Young Febrile Children.JAMA pediatrics · 2018Article
- Comparison of risk factors for, and prevalence of, antibiotic resistance in contaminating and pathogenic urinary Escherichia coli in children in primary care: prospective cohort study.The Journal of antimicrobial chemotherapy · 2018Article
- RCGP Research Paper of the Year 2016: how the winning papers are so relevant to clinical practice.The British journal of general practice : the journal of the Royal College of General Practitioners · 2017Article
- The Diagnosis of Urinary Tract Infection in Young Children (DUTY) Study Clinical Rule: Economic Evaluation.Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research · 2017Article
- High rates of multidrug resistance among uropathogenicAntimicrobial resistance and infection control · 2017Article
- The Need for Improved Detection of Urinary Tract Infections in Young Children.Frontiers in pediatrics · 2017Article
- Nappy pad urine samples for investigation and treatment of UTI in young children: the 'DUTY' prospective diagnostic cohort study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2016Article
Corrections and comments
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Authors and funding
25 authors at 9 institutions in 1 country.
Funding
Abstract
purposeUp to 50% of urinary tract infections (UTIs) in young children are missed in primary care. Urine culture is essential for diagnosis, but urine collection is often difficult. Our aim was to derive and internally validate a 2-step clinical rule using (1) symptoms and signs to select children for urine collection; and (2) symptoms, signs, and dipstick testing to guide antibiotic treatment.
methodsWe recruited acutely unwell children aged under 5 years from 233 primary care sites across England and Wales. Index tests were parent-reported symptoms, clinician-reported signs, urine dipstick results, and clinician opinion of UTI likelihood (clinical diagnosis before dipstick and culture). The reference standard was microbiologically confirmed UTI cultured from a clean-catch urine sample. We calculated sensitivity, specificity, and area under the receiver operator characteristic (AUROC) curve of coefficient-based (graded severity) and points-based (dichotomized) symptom/sign logistic regression models, and we then internally validated the AUROC using bootstrapping.
resultsThree thousand thirty-six children provided urine samples, and culture results were available for 2,740 (90%). Of these results, 60 (2.2%) were positive: the clinical diagnosis was 46.6% sensitive, with an AUROC of 0.77. Previous UTI, increasing pain/crying on passing urine, increasingly smelly urine, absence of severe cough, increasing clinician impression of severe illness, abdominal tenderness on examination, and normal findings on ear examination were associated with UTI. The validated coefficient- and points-based model AUROCs were 0.87 and 0.86, respectively, increasing to 0.90 and 0.90, respectively, by adding dipstick nitrites, leukocytes, and blood.
conclusionsA clinical rule based on symptoms and signs is superior to clinician diagnosis and performs well for identifying young children for noninvasive urine sampling. Dipstick results add further diagnostic value for empiric antibiotic treatment.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.