Mp21-03 Errors Related to the Evaluation and Management of Urinary Tract Infections in Children With Spina Bifida Presenting to the Emergency Department

You have accessJournal of UrologyPediatrics II (MP21)1 May 2024MP21-03 ERRORS RELATED TO THE EVALUATION AND MANAGEMENT OF URINARY TRACT INFECTIONS IN CHILDREN WITH SPINA BIFIDA PRESENTING TO THE EMERGENCY DEPARTMENT Nicole A. Belko, Victor Kucherov, Celicia Little, Nicole Allentuck, Christina Ho, Hans G. Pohl, Rana F. Hamdy, Elaise Hill, and Briony K. Varda Nicole A. BelkoNicole A. Belko , Victor KucherovVictor Kucherov , Celicia LittleCelicia Little , Nicole AllentuckNicole Allentuck , Christina HoChristina Ho , Hans G. PohlHans G. Pohl , Rana F. HamdyRana F. Hamdy , Elaise HillElaise Hill , and Briony K. VardaBriony K. Varda View All Author Informationhttps://doi.org/10.1097/01.JU.0001008844.84871.17.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Children with spina bifida (SB) who self-catheterize are at risk of being inappropriately treated for urinary tract infections (UTI). The objective of this study was to identify, categorize and prioritize factors leading to errors in the evaluation and management of UTIs in this population. METHODS: An institutional database of children with SB ≤21 years presenting to the ED between 2016 – 2020 was queried for visits with initiation of antibiotics for presumed UTI. An exploratory chart review of the initial ED visit and urine culture (UC) follow up was performed. A framework analysis was used to organize errors into those related to evaluation or management of symptoms, pyuria or UC results. The following criteria for a true UTI were applied: ≥2 urologic symptoms, pyuria >10 WBC/hpf and UC with >100k of a single organism. The proportion of visits with an error was calculated. A Pareto chart was created to identify and prioritize the most common type of errors. Baseline patient characteristics were collected and any additional observations relevant to errors were noted. RESULTS: There were 140 visits during which antibiotics were prescribed. Median age was 8 years and a majority were female (58%) and Hispanic (73%) with a supra-sacral (81%) myelomeningocele (76%). Errors occurred in 46% of visits (range of 0 – 3 errors per visit). Categories of errors included: treatment without symptoms, treatment without pyuria, continuation of antibiotics when UC had<100k organisms, initiation of antibiotics when UC had <100k organisms, and UC not obtained. Being treated without symptoms was the leading single error (32%), however the sum of errors occurring during UC follow up predominated (43%). Figure 1 summarizes the relative number of errors by category. Additional observations included: a UC call-back time range of 0 – 6 days, and when urology was consulted (11% of visits), 15% received antibiotics against recommendations. CONCLUSIONS: Errors in the evaluation and management of possible UTI occurred in almost half of ED visits. A leading target for improvement is antibiotic management during follow up of UC results. Improved symptom elicitation is a target for improvement in the pre-culture decision-making. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e329 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Nicole A. Belko More articles by this author Victor Kucherov More articles by this author Celicia Little More articles by this author Nicole Allentuck More articles by this author Christina Ho More articles by this author Hans G. Pohl More articles by this author Rana F. Hamdy More articles by this author Elaise Hill More articles by this author Briony K. Varda More articles by this author Expand All Advertisement PDF downloadLoading ...