title: Unexplained extra visits to general practitioners before the diagnosis of first urinary tract infection: a case-control study.
abstract: OBJECTIVE
  To determine: (1) whether children diagnosed with a urinary tract infection (UTI) visited their general practitioner (GP) more frequently before the diagnosis of UTI was established compared to children never diagnosed with a UTI; and (2) whether those children with evidence of renal scarring at their first diagnosed UTI visited their GPs more frequently before diagnosis compared to children who did not have evidence of renal scarring when their first UTI was investigated.
  
  
  METHODS
  Case-control study of 77 children with a UTI identified from a hospital radiology database (37 with and 40 without renal scarring), and 77 age, sex, and general practice matched controls. Main outcome measures were entries in general practice clinical records for types of illness, antibiotic prescriptions, and urine samples requested prior to the diagnosis of first UTI (cases) or equivalent time periods for controls.
  
  
  RESULTS
  Cases had a mean 2.94 additional visits or 21% more visits (95% CI 1% to 41%) in the period (mean 2.4 years) prior to the visit at which their first UTI was diagnosed, including a mean 2.5 additional visits or 23% more visits for infectious illness (95% CI 1% to 45%). The cases had 114% (95% CI 41% to 184%) more visits for symptoms relating to the genitourinary tract, though the actual number of these visits was small. They were febrile at 49% more visits (95% CI 1% to 99%) and received significantly more courses of antibiotics than controls (5.2 v 4.1). They had more urine samples requested (37 v 3). Both the cases with and without renal scarring had similar excess GP visits.
  
  
  CONCLUSIONS
  Compared to controls, children diagnosed with a first UTI had more visits at which symptoms of infection were recorded and more antibiotics prescribed prior to the visit at which the first UTI was diagnosed. These excess visits may have included undiagnosed UTIs. Both those with and without renal scarring had a similar degree of excess visits; additional aetiological factors must have played a role in scar formation.
authors.affiliation: KRUF Children's Kidney Centre, University Hospital of Wales, Cardiff CF14 4XW, UK. jhvandervoort@hotmail.com
authors.forename: J H
authors.initials: JH
authors.lastname: Van Der Voort
authors.forename: A G
authors.initials: AG
authors.lastname: Edwards
authors.forename: R
authors.initials: R
authors.lastname: Roberts
authors.forename: R G
authors.initials: RG
authors.lastname: Newcombe
authors.forename: K Verrier
authors.initials: KV
authors.lastname: Jones
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D002675:Child, Preschool; D002921:Cicatrix / Q000473:pathology; D005194:Family Practice; D005260:Female; D006801:Humans; D007668:Kidney / Q000473:pathology; D008297:Male; D009819:Office Visits / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000652:urine
chemical_list: D000900:Anti-Bacterial Agents