Katherine Bakes, MD reviewing Lavelle JM et al. Pediatrics 2016 Jul.

Reserving urethral catheterization for patients with a positive dipstick screen from bagged urine specimens reduced catheterization rates from 63% to 30%.

Investigators studied the effect of a quality-improvement initiative intended to decrease unnecessary urethral catheterization in febrile children aged 6 to 24 months presenting to a pediatric emergency department and evaluated for urinary tract infection (UTI). Prior to the initiative, young febrile children with suspected UTI underwent catheterization for urine collection. During a 6-month intervention period, such children had a urine bag placed and were encouraged to take oral hydration; only children with positive urine dipstick screens (moderate or large leukocyte esterase or presence of nitrites) underwent catheterization to collect urine for culture.

Similar percentages of febrile children were screened for UTI before and during the intervention (63% and 69%). Of the 828 children eligible for screening during the intervention period, 39% had bagged urine collection only, 16% were initially catheterized for urine collection at the treating physician's discretion, and 14% underwent catheterization after positive dipstick results on bagged urine specimens. Thus, catheterization rates among febrile children fell from 63% (all screened children) before the intervention to 30% during it; more than 350 unnecessary catheterizations were avoided during the intervention period. Children with bagged urine collection had the same median length of stay (276 minutes) as children screened prior to the intervention. There were no missed UTIs among roughly 39% of children during the intervention period who were followed within the hospital's network.

Citation(s):

Lavelle JM et al. Two-step process for ED UTI screening in febrile young children: Reducing catheterization rates. Pediatrics 2016 Jul; 138:e20153023.

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