Collecting the golden water: Quality assessment on approach of diagnosing urinary tract infections in 0 to 36 months old children.

OBJECTIVE: The study aimed to assess current practices of a community hospital for collection of urine sample when diagnosis of urinary tract infection (UTI) is suspected in children aged 0 to 36 months old. METHODS: An analysis of paediatric patients aged 0 to 36 months old was performed in two separate audits to assess the quality of urine sampling. The first, retrospective analysis comprised of urine collections techniques in a community hospital for diagnosis of UTI followed by an education intervention in which the hospital staff was briefed regarding the Canadian Paediatric Society (CPS) position statement for diagnosis and management of UTI. CPS recommendations were transposed using PowerPoint presentations, reminders at unit huddles, and other educational forums. Second audit was a prospective analysis which was conducted 6 months after the educations intervention. RESULTS: Bagged sampling had higher sensitivity and lower specificity due to sample contamination, versus transurethral bladder catheterization and suprapubic aspiration. The first audit showed that while 66% of culture-positive urine sampling was performed via the bagging, only 26% those positive cultures were repeated before treatment. In the second audit, after educational intervention, 33% of culture-positive urine collection was done via the bagging method and repeat testing was done in 83% of positive results on a bagged sample before initiating treatment. The false-positive rate for the diagnosis of UTIs in the first and second audit was 65.7 and 60%, respectively. CONCLUSION: Our study recognizes the flaws in community hospital practices in the diagnosis of UTI in children and validates the significance of educational intervention in improving health care.

Antenatal renal pelvic dilatation and foetal outcomes - review of cases from a tertiary care center in Karachi, Pakistan.

OBJECTIVE: To determine the incidence of antenatal renal pelvic dilatation to evaluate antenatal resolution/ progression and post-natal outcome. METHODS: This retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised data of all women found with renal pelvic dilatation in antenatal scans between January 2011 and December 2013. A cut-off of 5mm was used to diagnose renal pelvic dilatation. Renal pelvic dilatation was categorised into three groups: mild (5-6mm in second trimester and 5-9mm in third trimester), moderate (7-10mm in second trimester and 10-15 in third) and severe (more than 10mm in second trimester and more than 15mm in third trimester). RESULTS: Of the 13,337 scans, renal pelvic dilatation was found in 111(0.8%) cases. The overall mean maternal age was 28.5 ± 4.2 years. Renal pelvic dilatation was unilateral in 52(46.8%) and bilateral in 59(53.2%) cases. Post-natal scan was done in 61(55%) cases at the discretion of the neonatologist. A pathological finding was diagnosed in post-natal scan in 19(17.7 %) cases. Pelvi-ureteric junction obstruction was found in 6(5.4%) neonates, all in the severe renal pelvic dilatation category. CONCLUSIONS: The incidence of renal pelvic dilatation was low and the outcomes were normal in majority of cases.

The importance of visualization of appendix on abdominal ultrasound for the diagnosis of appendicitis in children: A quality assessment review.

BACKGROUND: Ultrasound has the first line investigation role in the diagnosis of acute appendicitis in children. The purpose of this study was to perform a quality assessment review on the visualization rate of appendix on ultrasound in children in the community hospital setting. METHODS: A retrospective chart review of the abdominal ultrasound findings for the visualization of the appendix was performed on paediatric patients ranging from 5 to 18 years. Data were collected from the two community hospitals of Toronto by using hospital electronic medical record for the ultrasound findings in patients presented with abdominal pain. RESULTS: Data from two community hospitals indicated visualization rate of the appendix as 11.0% and 23.2% for site 1 and site 2 respectively. In cases where the ultrasound was repeated the visualization rate remains the same. A two-proportion z-test was performed to find whether the visualization of appendix increases the likelihood of diagnosing appendicitis. The results revealed that the visualization of an appendix (P=0.52), significantly improved the diagnosis of appendicitis (z=34, P<0.001). CONCLUSION: Visualization of an appendix on ultrasound increases the likelihood of correctly diagnosing appendicitis. In our study, we found low visualization rate of appendix on ultrasound that could be the result of many factors that contribute towards the low visualization rate of an appendix on ultrasound. Hence, the challenges in identifying appendix should be minimized to improve the visualization and diagnosis of appendicitis on ultrasound.