Evaluation of the Bladder Stimulation Technique to Collect Midstream Urine in Infants in a Pediatric Emergency Department

• Published in: PloS one 2016-03, Vol.11 (3), p.e0152598-e0152598
• Main Authors: Tran, Antoine, Fortier, Clara, Giovannini-Chami, Lisa, Demonchy, Diane, Caci, Hervé, Desmontils, Jonathan, Montaudie-Dumas, Isabelle, Bensaïd, Ronny, Haas, Hervé, Berard, Etienne
• Format: Article
• Language: English
• Subjects: Age; Biology and Life Sciences; Bladder; Bladder training; Children; Children & youth; Cross-Sectional Studies; Diagnosis; Discomfort; Emergency medical care; Emergency medical services; Emergency Service, Hospital; Failure; Female; France; Health aspects; Hospitals, Pediatric; Humans; Infant; Infant, Newborn; Infants; Intubation; Male; Maneuvers; Medical personnel; Medicine and Health Sciences; Newborn babies; Normality; Odds Ratio; Pain; Pediatrics; People and Places; Physicians; Regression models; Risk analysis; Risk Factors; Statistical tests; Stimulation; Studies; Success; Training; Urinalysis; Urinary bladder; Urinary Bladder - physiology; Urinary tract; Urinary tract diseases; Urinary tract infections; Urinary Tract Infections - diagnosis; Urine; Urine Specimen Collection - methods; Urogenital system
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0152598

Midstream clean-catch urine is an accepted method to diagnose urinary tract infection but is impracticable in infants before potty training. We tested the bladder stimulation technique to obtain a clean-catch urine sample in infants. We included 142 infants under walking age who required a urine sample in a cross-sectional study carried out during a 3-months period, from September to November 2014, in the emergency department of the University Children's Hospital of Nice (France). A technique based on bladder stimulation and lumbar stimulation maneuvers, with at least two attempts, was tested by four trained physicians. The success rate and time to obtain urine sample within 3 minutes were evaluated. Discomfort (EVENDOL score ≥4/15) was measured. We estimated the risk factors in the failure of the technique. Chi-square test or Fisher's exact test were used to compare frequencies. T-test and Wilcoxon test were used to compare quantitative data according to the normality of the distribution. Risk factors for failure of the technique were evaluated using a multivariate logistic regression model. We obtained midstream clean-catch urine in 55.6% of infants with a median time of 52.0 s (10.0; 110.0). The success rate decreased with age from 88.9% (newborn) to 28.6% (>1 y) (p = 0.0001) and with weight, from 85.7% (10 kg) (p = 0.0004). The success rate was 60.8% for infants without discomfort (p