The position during urine sample collection from young precontinent children through a bag does not limit contamination rates: Results from a randomized controlled trial: Does infant position influence quality of urine collection?

AIM: Despite its limitation, bag collection is still widely used for a preliminary urine screening test in non-toilet-trained children suspected of febrile urinary tract infection. A previous study conducted by our group raised the hypothesis that the absence of direct contact between urine and the perinea during urine collection could limit urine contamination by perineal flora. The aim of this study was to evaluate the impact of the patient's position during urine collection (upright standing position versus free position) on the rate of contaminated urine samples in non-toilet-trained children with suspected febrile urinary tract infection. METHODS: This prospective, randomized, controlled study took place in seven pediatric emergency departments. Two groups were compared: the intervention group (infants held in an upright standing position during urination) and the control group (free position during urination). RESULTS: Among the 800 pediatric patients randomized to the study, 124 had a urine culture, 60 in the intervention group and 64 in the control group. Among the 124 urine cultures, 12 (9.7%) were contaminated: eight (13.3%) in the intervention group and four (6.3%) in the control group (p = 0.1824). CONCLUSION: The results show that the patient's position does not have a significant impact on the quality of urine samples collected by bag.

Evaluation of bladder stimulation as a non-invasive technique for urine collection to diagnose urinary tract infection in infants under 6 months: a randomized multicenter study ("EE-Sti.Ve.N").

BACKGROUND: Febrile urinary tract infection (UTI) is common in infants and needs to be diagnosed quickly. However, the symptoms are non-specific, and diagnosis can only be confirmed after high quality urinalysis. The American Academy of Pediatrics recommends suprapubic aspiration (1-9% contamination) and urinary catheterization (8-14% contamination) for urine collection but both these procedures are invasive. Recent studies have shown a new non-invasive method of collecting urine, bladder stimulation, to be quick and safe. However, few data about bacterial contamination rates have been published for this technique. We hypothesize that the contamination rate of urine collection by bladder stimulation to diagnose febrile UTI in infants under 6 months is equivalent to that of urinary catheterization. METHODS/DESIGN: This trial aims to assess equivalence in terms of bacterial contamination of urinary samples collected by urinary catheterization and bladder stimulation to diagnose UTI. Seven hundred seventy infants under 6 months presenting with unexplained fever in one of four Pediatric Emergency Departments in France will be enrolled. Each child will be randomized into a bladder stimulation or urinary catheterization group. The primary endpoints will be the validity of the urine sample assessed by the presence of contamination on bacterial culture. CONCLUSION: A high recruitment rate is achievable due to the high prevalence of suspected UTIs in infants. The medical risk is the same as that for routine clinical care as we analyze patients with isolated fever. If our hypothesis holds true and the rate of urine contamination collected by bladder stimulation is acceptable, the infants included in the study will have benefited from a non-invasive and reliable means of collecting urine. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03801213. Registered on 11 January 2019.

[A short track to relieve pediatric emergency department overload]. / Un circuit court pour désengorger les services d'accueil des urgences pédiatriques.

INTRODUCTION: The number of emergency pediatric consultations continues to rise in France. The pediatric emergency department (PED) introduced relocated consultations (RlCs) for unwarranted visits to relieve the overload of emergency medical consultations. The objective of this study was to assess the advantages of implementing these RlCs. METHODS: A single-center prospective study was undertaken from 21st January to 18 March 2012, with RlCs opened on weekends from 1 to 8 pm in the PED of the Nice Lenval University Hospital Center. All children referred for medical reasons during this period were included. One out of two children labeled stage 5 were transferred to the RlCs. The data evaluated were waiting time, duration of the medical consultation, transit time, and patient and medical staff satisfaction. RESULTS: Eight hundred and seventy-five patients were included. All patients in stages 1-2, 3, 4, and 5, relocated or not, had a mean waiting time before the medical consultation lasting 39.1, 57.7, 54.8, 70.5, and 52.7 min, respectively. The mean duration of the medical consultation was longer for stages 1-2 (61.6 min). The total time spent in the PED did not differ between stage 5 patients who were not relocated (121.3 min) and stages 1-2 (118 min), but both were longer than stage 5 patients who were relocated (90.3 min). Patients and medical staff expressed overall satisfaction during this period. DISCUSSION: By relocating one out of two stage 5 children, waiting times and consultation times decreased for all patients consulting at the PED. These results confirm that implementing RlCs has improved working conditions and quality of patient management.