Data from: Evaluation of the bladder stimulation technique to collect midstream urine in infants in a pediatric emergency department

Objective: 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. Materials and methods: 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. Results: 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% (<4kg) to 28.6% (>10kg) (p=0.0004). The success rate was 60.8% for infants without discomfort (p<0.0001). Heavy weight and discomfort were associated with failure, with adjusted ORs of 1.47 [1.04-2.31] and 6.65 [2.85-15.54], respectively. Conclusion: Bladder stimulation seems to be efficient in obtaining midstream urine with a moderate success rate in our study sample. This could be an alternative technique for infants before potty training but further randomized multicenter studies are needed to validate this procedure.

研究目的：中段清洁尿（midstream clean-catch urine）是诊断尿路感染的公认方法，但对于尚未完成如厕训练的婴儿而言，该留尿方式并不可行。本研究旨在评估膀胱刺激技术用于获取婴儿清洁尿样本的效果。
材料与方法：本研究为横断面研究，于2014年9月至11月的3个月周期内，在法国尼斯大学儿童医院急诊科开展，共纳入142名处于行走前年龄段、需留取尿样本的婴儿。由4名经过培训的医师采用基于膀胱刺激与腰部刺激操作的留尿技术，且至少进行2次尝试。本研究评估了样本获取成功率以及3分钟内完成尿样本留取的耗时情况，同时记录受试者的不适程度（EVENDOL评分≥4/15）。我们对该技术留尿失败的危险因素进行了分析。采用卡方检验或Fisher确切概率法比较组间频次；根据数据分布的正态性，采用t检验或Wilcoxon秩和检验比较定量数据。使用多因素logistic回归模型评估该技术失败的独立危险因素。
结果：本研究中55.6%的婴儿成功留取中段清洁尿，中位耗时为52.0秒（四分位距：10.0~110.0秒）。留尿成功率随年龄增长从88.9%（新生儿组）降至28.6%（>1岁组）（p=0.0001），随体重增加从85.7%（<4kg组）降至28.6%（>10kg组）（p=0.0004）。无不适症状的婴儿留尿成功率为60.8%（p<0.0001）。高体重与不适症状均与留尿失败风险显著相关，校正后的比值比分别为1.47[1.04-2.31]与6.65[2.85-15.54]。
结论：在本研究样本中，膀胱刺激技术用于获取中段尿样本具有一定有效性，留尿成功率中等。该技术可作为尚未完成如厕训练的婴儿的备选留尿方案，但仍需开展进一步的多中心随机对照研究以验证该操作的临床有效性。