ESPN 50th Annual Meeting

ESPN 2017


 
Comparison of pain experienced during urine collection with transurethral catheterization or urine bag collection in non-toilet-trained children: a non-inferiority study
CLAIRE DE JORNA-LECOUVEY 1 AMéLIE RYCKEWAERT 1 KARIMA HAMMAS 1 ALEXIS ARNAUD 1

1- RENNES UNIVERSITY HOSPITAL (FRANCE)
 
Introduction:

Urine collection from non-toilet-trained children is a daily challenge in pediatric emergency departments to diagnose urinary tract infections (UTI). Guidelines recommend to use transurethral catheterization (TUC) to obtain uncontaminated urine samples. As TUC is often considered as a painful procedure, non-invasive urine bag collection (UBC) remains widely used despite its high contamination risk.The aim of this study was to demonstrate that TUC is not significantly more painful than urine bag removal.

 

Material and methods:

A prospective, observational, monocentric, non-inferiority study was conducted. Children aged 0 to 3 years, non-toilet-trained and presenting at the pediatric emergency department with a suspicion of UTI were eligible. Pain and experience of the procedure during transurethral catheterization or urine bag removal were assessed independently by nurses and parents using a questionnaire. The primary outcome was the mean pain score as assessed by the nurse using a visual analog scale (VAS, range of score: 0-10). A non-inferiority margin of 2 points on the VAS was chosen.

Results:

One hundred patients were included (50 per group). Mean age was 10.2 months ± 8.2. The mean VAS score assessed by nurses was 1.9 ± 2.1 in the TUC group and 0.9 ± 1.5 in the UBC group. The difference of VAS between the groups was 1.0 point with an upper limit of the unilateral 95% confidence interval of 1.6. The pain assessed by nurses during catheterization was not significantly superior to the pain during urine bag removal. In the TUC group 84.0% of parents and 77.6% of nurses reported that the procedure went well or very well.

 

Conclusions:

Transurethral catheterization is not more painful than bag’s withdrawal, with a good parental and nurses’ experience of the procedure. This should encourage health professionals to follow the actual guidelines recommending to use TUC whose bacteriological superiority is well established.