Clinical Training of Primary Health Care Physicians to Reduce False Positive Diagnoses of Pediatric Urinary Tract Infections | OMICS International

Background: Presumptive clinical diagnosis of？pediatric urinary tract infections (UTI) remains in practice in many？low- and middle-income countries in spite of its limited accuracy; improving its precision could be potentially useful？until more accurate methods can be implemented in resource-limited locations. Objective: To assess whether clinical training can result in a reduction of false positive diagnoses of pediatric？UTIs. Methods: A non-randomized pragmatic trial was conducted in six medical units. Each arm included doctors from？two units. Those in the first (IG9, n=14) and second (IG20, n=14) group received 9 h and 20 h training, respectively;？the control group (CG, n=17) received none. Training in the IG9 consisted of three sessions lasting 3 h each, one？per week over three consecutive weeks, and for the IG20 training spread over five weeks with two 2 h sessions per？week. Sessions were led by an expert pediatrician covering relevant UTI topics; focus was given on common signs？and symptoms including fever of unknown origin, urinary urgency, hematuria, dysuria, fetid urine, and suprapubic？pain. A total of 134 children between two months and nine years were diagnosed; 41, 44, and 49 from the CG, IG9？and IG20, respectively. The main measure of effect was the difference in the proportions of accurate positive clinical？diagnoses between the trained groups and the control using urine culture as standard. Adjusted odds ratios (OR)？from binary logistic regression were computed to estimate the probability of correctly diagnosing a UTI adjusting by？physicians’ sex, age, years of experience, postgraduate education, and ？re-training knowledge. Results: The proportion of accurate diagnoses was 39.0, 27.3 and 32.7% in the CG, IG9 and IG20, respectively.？Doctors trained for 9 or 20 h had a non-significantly lower chance of a correct diagnosis (OR; 95% CI for IG9=0.57;0.21-1.5, IG20=0.55; 0.21-1.4). Conclusion: Training did not reduce false positives diagnoses. Confirmatory methods are required to diagnose？UTIs in children with symptomatology