Quality statement 1: Presentation with unexplained fever of 38°C or higher

Quality statement

Infants, children and young people presenting with unexplained fever of 38°C or higher have a urine sample tested within 24 hours.

Rationale

It is important that a urinary tract infection is considered as a cause of feverish illness in infants, children and young people. When an infant, child or young person (under 16 years) presents to a healthcare practitioner with a temperature of 38°C or higher, and there is no obvious source of the infection, a urine sample should be tested within 24 hours to ensure prompt diagnosis and antibiotic treatment if appropriate.

Quality measures

Structure

Evidence of local arrangements to ensure that infants, children and young people (under 16 years) who present with unexplained fever of 38°C or higher have a urine sample tested within 24 hours.

Data source: Local data collection.

Process

Proportion of infants, children and young people who present with unexplained fever of 38°C or higher who have a urine sample tested within 24 hours.

Numerator – the number of people in the denominator who have a urine sample tested within 24 hours.

Denominator – the number of infants, children and young people (under 16 years) presenting with unexplained fever of 38°C or higher.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers ensure that systems are in place for infants, children and young people presenting with unexplained fever of 38°C or higher to have a urine sample tested within 24 hours.

Healthcare practitioners ensure that infants, children and young people presenting with unexplained fever of 38°C or higher have a urine sample tested within 24 hours.

Commissioners ensure that they commission services for infants, children and young people presenting with unexplained fever of 38°C or higher that carry out testing of urine samples within 24 hours.

Infants, children and young people under 16 with a temperature of 38°C or higher and no obvious infection have a urine sample tested within 24 hours of seeing a healthcare professional.

Source guidance

Urinary tract infection in under 16s: diagnosis and management (2018) NICE guideline CG54, recommendations 1.1.1.1, 1.1.5.2, 1.1.5.3, 1.1.5.4 and 1.1.5.5

Definitions of terms used in this quality statement

Although all infants, children and young people with symptoms and signs suggesting urinary tract infection should have a urine sample tested for infection, this statement relates specifically to those presenting with unexplained fever of 38°C or higher.

A urinary tract infection may be the cause of fever if there is no obvious source of infection and there is no alternative diagnosis.

The NICE guideline on urinary tract infection in under 16s recommends urine-testing strategies according to 3 separate age groups. The urine-testing strategies are grouped as follows:

  • infants younger than 3 months

  • infants and children 3 months or older but younger than 3 years

  • children 3 years or older.

Assess the risk of serious illness in line with the NICE guideline on fever in under 5s to ensure appropriate urine tests and interpretation, both of which depend on the child's age and risk of serious illness.