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Point-of-care ultrasound before attempting clean-catch urine collection in infants: a randomized controlled trial

  • Olivia Weill (a1), Mélanie Labrosse (a1), Arielle Levy (a1), Marie Pier Desjardins (a1), Evelyne D. Trottier (a1) and Jocelyn Gravel (a1)...
Abstract
Objective

A new non-invasive bladder stimulation technique has been described to obtain clean-catch urine specimens in infants. This study aimed to evaluate if point-of-care ultrasound (POCUS) guided feeding protocol to measure bladder volume prior to stimulation techniques improves clean-catch urine collection success.

Methods

A prospective randomized controlled trial study was conducted in a tertiary care pediatric emergency department. Infants aged less than 6 months needing a urine sample were randomized to either POCUS group or feeding group (standard procedure) before performing a standardized clean-catch urine stimulation technique. In the POCUS group, a feeding period was permitted if the bladder width was less than 2 cm, otherwise the clean-catch urine was performed immediately. The primary outcome was the success of the procedure defined by the collection of at least 2 mL of urine, obtained within 300 seconds of bladder stimulation manoeuvres. It was estimated that the recruitment of 200 children was necessary to yield 80% power to identify an improvement of 20% in the success rate.

Results

A total of 201 infants were included. The procedure was not more successful in the POCUS group (48%) compared to the feeding group (54%) (Difference: 6.5%; 95% CI: -7.3 to 19.8%). The mean time to collect urine samples from randomization to sample collection was not different between the two groups.

Conclusions

Our study failed to show a benefit of using POCUS to improve the success rate of stimulated clean-catch urine. Moreover, the importance of the feeding period prior to clean-catch urine manoeuvres should be evaluated further.

Clinical Trial Registration

NCT02751671

Objectif

Une nouvelle technique de prélèvement urinaire non-invasive par mi-jet stimulé fut décrite pour les nourrissons. L’étude visait à évaluer si un protocole d’allaitement guidé par l’échographie au chevet (EC), avant stimulation, pour mesurer le volume de la vessie, permettait d’accroître le taux de réussite du recueil d’urine par mi-jet.

Méthode

Un essai comparatif, prospectif et à répartition aléatoire a été mené dans un service des urgences pédiatriques de soins tertiaires. Des nourrissons âgés de moins de 6 mois chez qui devait être pratiqué un prélèvement d’urine ont été répartis au hasard dans le groupe de l’EC ou dans le groupe d’allaitement (méthode courante) avant que ne soit pratiquée la technique de stimulation uniforme de recueil d’urine par mi-jet. Dans le groupe de l’EC, l’allaitement était permis si la largeur de la vessie était < 2 cm; sinon, l’on procédait immédiatement au recueil d’urine par mi-jet stimulé. Le principal critère d’évaluation consistait en la réussite du prélèvement, défini comme le recueil d’au moins 2 ml d’urine pendant les manœuvres de stimulation de la vessie, d’une durée maximum de 300 secondes. D’après l’évaluation des chercheurs, le nombre de sujets nécessaire pour que l’étude atteigne une puissance de 80% et mette ainsi en évidence une augmentation de 20% du taux de réussite devait s’élever à 200.

Résultats

Au total, 201 nourrissons ont participé à l’étude. Le recueil d’urine n’était pas plus élevé dans le groupe de l’EC (48%) que dans le groupe d’allaitement (54%) (écart : 6,5%; IC à 95% : -7,3% à 19,8%). Il n’y avait de différence non plus entre les deux groupes quant au temps moyen écoulé depuis la répartition aléatoire des sujets jusqu’au prélèvement d’urine.

Conclusion

La supériorité de l'EC dans l'accroissement du taux de réussite du recueil d'urine non souillée par stimulation n'a pas été démontrée dans l’étude. Il faudrait aussi évaluer davantage l'importance de la durée de l'allaitement avant les manœuvres de recueil d'urine non souillée.

No d'enregistrement des essais cliniques

NCT02751671

Copyright
Corresponding author
Correspondence to: Dr. Olivia Weill, Division of Emergency Medicine, CHU Sainte-Justine, 3175, Chemin de la Côte-Sainte-Catherine, Montréal, QC H3T1C5; Email: olivia.weill@umontreal.ca
References
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Canadian Journal of Emergency Medicine
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Supplementary materials

Weill et al. supplementary material
Web Appendix Figure 3 and Table 3

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Supplementary materials

Weill et al. supplementary material
CONSORT Checklist

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