Abstract
Background:
UTI in the elderly is a diagnostically challenging Emergency Department (ED) infection. UK Health Security Agency (UKHSA) diagnostic tool use is promoted in England.
Aim:
To assess feasibility of chart review to quantify alignment with UKHSA guidelines.
Methods:
Population: patients attending ED; ≥65 years; primary UTI diagnosis; not admitted. Clinical notes reviewed for UTI symptoms/signs and associated: (i) urine dipstick; (ii) urine sent for microscopy, culture, and sensitivity (MC&S); (iii) antibiotic treatment. Management considered aligned if: (i) documented symptoms/signs match diagnostic criteria and (ii) testing and treatment as recommended. Data collection time recorded.
Results:
6076 ED attendances 65+, August-October 2021;116 (not admitted) with UTI related descriptor; 40 treated as UTI.
Documented symptoms/signs aligned with lower UTI/pyelonephritis diagnostic criteria in 27/40 (67.5%); recommendation of no dipstick, urine sample (MC&S), antibiotic treatment followed in 7, 16 and 26 of 27, respectively.
Thirteen of 40 (32.5%) had no documented aligned UTI symptoms/signs; consequent recommendation of no dipstick, no urine sample (MC&S), no antibiotic treatment followed in 5, 7 and 4 of 13 respectively.
Five of 40 (12.5%) followed recommended pathway; 30/40 (75%) received recommended treatment; unnecessary tests included 27 dipsticks and 6 urine samples; urine sample recommended but not taken in 11 patients.
Time to collect data: 20 hrs.
Discussion:
Alignment with UKHSA guidelines is low, possibly due to poor documentation. Testing where symptoms not aligned appeared to result in unnecessary antibiotics. Chart review is probably not feasible for larger studies. Future research could investigate if alignment is associated with patient outcomes.
UTI in the elderly is a diagnostically challenging Emergency Department (ED) infection. UK Health Security Agency (UKHSA) diagnostic tool use is promoted in England.
Aim:
To assess feasibility of chart review to quantify alignment with UKHSA guidelines.
Methods:
Population: patients attending ED; ≥65 years; primary UTI diagnosis; not admitted. Clinical notes reviewed for UTI symptoms/signs and associated: (i) urine dipstick; (ii) urine sent for microscopy, culture, and sensitivity (MC&S); (iii) antibiotic treatment. Management considered aligned if: (i) documented symptoms/signs match diagnostic criteria and (ii) testing and treatment as recommended. Data collection time recorded.
Results:
6076 ED attendances 65+, August-October 2021;116 (not admitted) with UTI related descriptor; 40 treated as UTI.
Documented symptoms/signs aligned with lower UTI/pyelonephritis diagnostic criteria in 27/40 (67.5%); recommendation of no dipstick, urine sample (MC&S), antibiotic treatment followed in 7, 16 and 26 of 27, respectively.
Thirteen of 40 (32.5%) had no documented aligned UTI symptoms/signs; consequent recommendation of no dipstick, no urine sample (MC&S), no antibiotic treatment followed in 5, 7 and 4 of 13 respectively.
Five of 40 (12.5%) followed recommended pathway; 30/40 (75%) received recommended treatment; unnecessary tests included 27 dipsticks and 6 urine samples; urine sample recommended but not taken in 11 patients.
Time to collect data: 20 hrs.
Discussion:
Alignment with UKHSA guidelines is low, possibly due to poor documentation. Testing where symptoms not aligned appeared to result in unnecessary antibiotics. Chart review is probably not feasible for larger studies. Future research could investigate if alignment is associated with patient outcomes.
| Original language | English |
|---|---|
| Publication status | Published - 22 Sept 2023 |
| Event | General Practice Research on Infections Network Conference - Aalborg, Denmark Duration: 22 Sept 2023 → 23 Sept 2023 |
Conference
| Conference | General Practice Research on Infections Network Conference |
|---|---|
| Country/Territory | Denmark |
| City | Aalborg |
| Period | 22/09/23 → 23/09/23 |