Urinary tract infections (UTI) (Paediatric Surgery)
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Emergency
If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.
Paediatric surgery registrars at Queensland Children's Hospital/ GCUH can offer telephone advice to rural HHS. In some areas it would be more appropriate to seek initial advice from local paediatric medical service or general surgery services:
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Queensland Children's Hospital: 07 3068 1111
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GCUH: 1300 744 284
Burns
All major burns require emergency management and referral
The Paediatric Burns Centre (PBC), Qld Children's Hospital offers a 24/7 referral service. For a referral coming from regional QLD, an email referral service is available. Criteria for referring to our service is based on the Australian New Zealand Burns Association transfer guidelines for Burns Service referral.
- For those burns located in the Mackay region and above, please refer to Townsville Hospital first (07) 4433 1111
- For those burns located in the Gold Coast region and below to Grafton NSW, please refer to Gold Coast University Hospital first. Paediatric surgical registrar or on call surgical cover 1300 744 284
If these hospitals are unable to care for the patient, then please follow the information below to refer to PBC
To refer a patient to the Paediatric Burns Centre (Qld Children's Hospital);
- Contact the Burns Register on call via switch (07) 3068 1111
- Complete Category 1 Referral to Burns Outpatients (QH staff only)
- Submit referral form by clicking 'submit at the end of the form or by emailing through to burns-opd@health.qld.gov.au
- Attach any photos to this email if possible
- If advised that the patient can be treated locally, continue to contact the burns Registrar at each dressing change to update progress and send through photos to above email address
All paediatric patients should be referred to the PBC however they may not physically be required to attend the Queensland Children's hospital. If treatment can be managed in the local area, then this is the preferred treatment
Antenatal & neonatal surgical conditions
- Patients with congenital malformations causing bowel obstruction or respiratory compromise are emergency referrals not outpatients. Resuscitation and safe transfer to tertiary paediatric unit is a priority. Notify neonatal unit or appropriate neonatal/paediatric medical specialist of neonatal/fetal diagnosis as per local protocol.
- Acute neonatal bowel obstruction
Enlarged lymph nodes/midline neck swelling
- Acute infective node with no improvement within 48 hours
- Nodes rapidly increasing in size, overlying skin erythema or very tender
- Acute infection not responding to treatment/antibiotics present to emergency
Umbilical and peri umbilical pathology
- Any painful, red, or irreducible hernia – discuss with on-call paediatric surgical registrar
- Suspected vitello-intestinal remnant or patent urachus
Abdominal pain - chronic
- Acute abdominal pain (suspected serious pathology) especially severe pain or peritonitis
- Intussusception
- Hypertrophic pyloric stenosis
- Suspected bowel obstruction with bile stained vomiting
- Suspected malignancy – discuss with on-call paediatric surgical registrar if serious pathology is suspected
Perineal conditions
- Severe pain or peritonitis
Perianal conditions
- Acute abscess
Constipation and encopresis
- Acute neonatal bowel obstruction
Vomiting
- Bile stained vomiting is a surgical emergency – phone the on-call paediatric surgical registrar,
- Suspected pyloric stenosis – phone the on-call paediatric surgical registrar
Stomas and abdominal devices
- Accidental removal of gastrostomy button or ACE tubing – phone on-call paediatric surgical registrar
- Any stomal or abdominal device issues refer to treating hospital
Hernia, hydrocele and testicular conditions
- Irreducible, incarcerated or strangulated inguinal hernia
- Suspected testicular torsion
- Inguinal hernia: If under <52 weeks post conceptual age, call nearest paediatric surgical unit for urgent review
- Acute scrotal pain with or without swelling
- Ambiguous genitalia and neonatal bilateral undescended testes are urgent referrals to service
Renal and bladder congenital lesions
- Acute retention
- Poor urinary stream in neonate / suspected valves
Urinary tract infections (UTI)
- Acute infant urinary tract infection presenting septicaemia or acutely unwell
- Hypertension > 97 percentile for age and/or height
- Presumed UTI in infant <3 months
Penile conditions
- Paraphimosis (when unable to replace foreskin)
- Disorder of sexual development (DSD) – refer to paediatric surgeon or paediatric medicine immediately
Skin and soft tissue masses
- Acute breast infection requiring admission or drainage
- Acute infection - if unresponsive to treatment or acutely unwell from infection
- Suspected solid paediatric tumours should be urgently referred through local paediatric medical service and/or paediatric oncology services
Vascular anomalies/haemangioma
- Obstruction of vision, airway compromise, uncontrolled bleeding, ulceration, suspected kapsiform haemangioendothelioma (KHE) or cardiac output compromise - contact paediatric surgical registrar on call
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Other useful information for referring practitioners Not and exhaustive list
Minimum Referral Criteria
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Category 1
(appointment within 30 calendar days)- Child with known renal tract abnormalities
- Significant neonatal renal pelvic dilatation (>15mm or >10mm if bilateral)
- Concerns regarding obstruction
The following conditions could be referred to general paediatrics or paediatric surgery depending on the service and underlying condition
- Infants and children > 3 months with history of acute pyelonephritis/upper urinary tract infection
- Infants ≤ 6 months presenting with 1st UTI (after acute episode)
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Category 2
(appointment within 90 calendar days)- Recurrent UTI with abnormal imaging results not category one
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Category 3
(appointment within 365 calendar days)- No category 3 criteria
Please insert the below information and minimum referral criteria into referral
1. Reason for request Indicate on the referral
- To establish a diagnosis
- For treatment or intervention
- For advice and management
- For specialist to take over management
- Reassurance for GP/second opinion
- For a specified test/investigation the GP can't order, or the patient can't afford or access
- Reassurance for the patient/family
- For other reason (e.g. rapidly accelerating disease progression)
- Clinical judgement indicates a referral for specialist review is necessary
2. Essential referral information Referral will be returned without this
- Evaluate adequacy of urinary stream
- MSU MCS results (clean catch)
- infants and children presenting with unexplained fever of 38°C or higher should have a urine sample tested after 24 hours at the latest
- Renal tract USS results
- <1 year old first UTI
- children of any age with recurrent UTI
- children any age with an atypical UTI or UTI responding poorly to treatment
3. Additional referral information Useful for processing the referral
Highly desirable information – may change triage category
- Frequency of urinary tract infections and age of first onset
- A reliable urine specimen is vital to confirm the diagnosis – urine bags must not be used (high false positive rate)
- Urinalysis (dipstick)
Desirable information- will assist at consultation
- History of constipation, fluid intake, poor hygiene
- Other past medical history
- Immunisation history
- Developmental history
- Medication history
- Significant psychosocial risk factors (esp. parents mental health, family violence, housing and financial stress, department of child safety involvement)
- Height/weight/head circumference and growth charts with prior measurements if available.
- Other physical examination findings inclusive of CNS, birth marks or dysmorphology
- Any relevant laboratory results or medical imaging reports (high false positive rate)
4. Request
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General referral information
Patient's Demographic Details
- Full name (including aliases)
- Date of birth
- Residential and postal address
- Telephone contact number/s – home, mobile and alternative
- Medicare number (where eligible)
- Name of the parent or caregiver (if appropriate)
- Preferred language and interpreter requirements
- Identifies as Aboriginal and/or Torres Strait Islander
Referring Practitioner Details
- Full name
- Full address
- Contact details – telephone, fax, email
- Provider number
- Date of referral
- Signature
Relevant clinical information about the condition
- Presenting symptoms (evolution and duration)
- Physical findings
- Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
- Body mass index (BMI)
- Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
- Current medications and dosages
- Drug allergies
- Alcohol, tobacco and other drugs use
Reason for request
- To establish a diagnosis
- For treatment or intervention
- For advice and management
- For specialist to take over management
- Reassurance for GP/second opinion
- For a specified test/investigation the GP can't order, or the patient can't afford or access
- Reassurance for the patient/family
- For other reason (e.g. rapidly accelerating disease progression)
- Clinical judgement indicates a referral for specialist review is necessary
Clinical modifiers
- Impact on employment
- Impact on education
- Impact on home
- Impact on activities of daily living
- Impact on ability to care for others
- Impact on personal frailty or safety
- Identifies as Aboriginal and/or Torres Strait Islander
Other relevant information
- Willingness to have surgery (where surgery is a likely intervention)
- Choice to be treated as a public or private patient
- Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
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Notes
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Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
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A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.
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Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.
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