Background: IgA vasculitis, also known as Henoch–Schönlein purpura, is the most common small-vessel vasculitis in children. It presents with a purpuric rash, and may cause joint and abdominal pain, haematuria, proteinuria and hypertension. Renal involvement occurs in 30–50% of cases, making follow-up essential to monitor for renal disease, as well as recurrence.Diagnosis is mainly clinical, but urinalysis, height-adjusted blood pressure (BP) measurement, and selected blood tests help confirm the diagnosis and exclude differentials such as meningococcal sepsis.Local guidelines recommend urine dip and microscopy, and height-adjusted BP at first presentation, which is also advised by the UK Kidney Association. Blood tests (renal function, inflammatory markers) should be reserved for uncertain cases. Follow-up for urinalysis and BP is advised at 48 hours, 2 weeks, and 3 months.Method: We retrospectively reviewed electronic hospital data for children presenting with a first episode of IgA vasculitis to the emergency department between January 2022 and January 2025. Re-presenters, insufficient documentation, or alternative diagnoses were excluded. A total of 52 children fit the inclusion criteria; 8 patients were excluded.We assessed whether urinalysis, height-adjusted BP, and follow-up at 48 hours, 2 weeks, and 3 months were completed as per local guidance.Interventions included a teaching session, departmental audit presentation, and introduction of an IgA vasculitis proforma (containing adjusted BP charts, investigation flowcharts, referral forms and patient information), which was made available across paediatric emergency units.Results: Data analysis demonstrated 98% of children had BP recorded but only 6% adjusted this for height. A urine dip was performed in 96%, yet only 19% had microscopy sent. All children had blood tests, with 94% including inflammatory markers; 25% had CRP >10, and 9% >20. 40% of children had positive urine dip findings for protein or blood.Follow-up was inconsistent; 63% at 48 hours, 48% at 2 weeks, and 61% at 3 months.Prior to the teaching session, 60% of paediatric doctors were not confident in investigating IgA vasculitis and 70% were unaware of local guidance. Key barriers included referral difficulties and unclear follow-up processes. After teaching, confidence in guideline knowledge rose to 90%.Conclusions: Our audit demonstrates poor adherence to local guidance for investigating IgA vasculitis. Whilst urine dip was performed well, a lack of microscopy risks missing haematuria or proteinuria. This proved particularly relevant, as 40% of patients had a positive urine dip; when compared to the proportion of patients with a raised CRP, highlighting the diagnostic value of comprehensive urinalysis.Failure to adjust BP may lead to inaccurate interpretation, increasing the likelihood of missed renal complications. This, compounded with the lack of follow-up, particularly at 2 weeks, risks missing children who may develop further organ involvement or those at risk of recurrence or symptom relapse.Future directions: We aim to re-audit these parameters over the next 6 to 12 months following implementation of the proforma which is readily available to doctors working in the children’s emergency department. This should aid in ensuring all relevant investigations are performed and follow-up arrangements are made.
