Pragmatic evaluation of a midstream urine collection technique for infants in the emergency department
- 1 September 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in CJEM
- Vol. 22 (5), 665-672
- https://doi.org/10.1017/cem.2020.31
Abstract
Objectives Our objective was to examine the performance characteristics of a bladder stimulation technique for urine collection among infants presenting to the emergency department (ED). Methods This prospective cohort study enrolled a convenience sample of infants aged <= 90 days requiring urine testing in the ED. Infants were excluded if critically ill, moderately to severely dehydrated, or having significant feeding issues. Bladder stimulation consisted of finger tapping on the lower abdomen with or without lower back massage while holding the child upright. The primary outcome was successful midstream urine collection within 5 minutes of stimulation. Secondary outcomes included sample contamination, bladder stimulation time for successful urine collection, and perceived patient distress on a 100-mm visual analog scale (VAS). Results We enrolled 151 infants and included 147 in the analysis. Median age was 53 days (interquartile range [IQR] 27-68 days). Midstream urine sample collection using bladder stimulation was successful in 78 infants (53.1%; 95% confidence interval [CI] 45-60.9). Thirty-nine samples (50%) were contaminated. Most contaminated samples (n = 31; 79.5%) were reported as "no significant growth" or "growth of 3 or more organisms". Median bladder stimulation time required for midstream urine collection was 45 seconds (IQR 20-120 seconds). Mean VAS for infant distress was 22 mm (standard deviation 23 mm). Conclusions The success rate of this bladder stimulation technique was lower than previously reported. The contamination rate was high, however most contaminated specimens were easily identified and had no clinical impact.This publication has 21 references indexed in Scilit:
- Diagnosis of Urinary Tract Infections in ChildrenJournal of Clinical Microbiology, 2016
- Evaluation of the Bladder Stimulation Technique to Collect Midstream Urine in Infants in a Pediatric Emergency DepartmentPLOS ONE, 2016
- Accuracy of a new clean-catch technique for diagnosis of urinary tract infection in infants younger than 90 days of agePaediatrics & Child Health, 2015
- Diagnostic Accuracy of the Urinalysis for Urinary Tract Infection in Infants <3 Months of AgePEDIATRICS, 2015
- Midstream clean-catch urine collection in newborns: a randomized controlled studyEuropean Journal of Pediatrics, 2014
- Contamination rates of different urine collection methods for the diagnosis of urinary tract infections in young children: An observational cohort studyJournal of Paediatrics and Child Health, 2012
- THE “OUCHLESS EMERGENCY DEPARTMENT*”Pediatric Clinics of North America, 1999
- The visual analogue pain intensity scale: what is moderate pain in millimetres?Pain, 1997
- Six year follow up of infants with bacteriuria on screening.BMJ, 1990