Department of Pediatrics, Division of Emergency Medicine, CHU Sainte-Justine, Université de Montréal, Montréal, QC.
CJEM. 2019 Sep;21(5):646-652. doi: 10.1017/cem.2019.30.
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.
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.
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.
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.
NCT02751671.
已经描述了一种新的非侵入性膀胱刺激技术，以获取婴儿的清洁尿标本。本研究旨在评估在刺激技术之前使用即时超声（POCUS）引导喂养方案测量膀胱容量是否能提高清洁尿采集成功率。
在一家三级儿科急诊病房进行了一项前瞻性随机对照试验研究。需要尿液样本的年龄小于 6 个月的婴儿被随机分配到 POCUS 组或喂养组（标准程序），然后再进行标准化的清洁尿刺激技术。在 POCUS 组，如果膀胱宽度小于 2 厘米，则允许进行喂养期，否则立即进行清洁尿采集。主要结局是通过膀胱刺激操作后 300 秒内收集至少 2 毫升尿液的程序成功定义。估计需要招募 200 名儿童才能达到 80%的效力，以确定成功率提高 20%。
共纳入 201 名婴儿。与喂养组（54%）相比，POCUS 组（48%）的操作成功率没有更高（差异：6.5%；95%CI：-7.3 至 19.8%）。从随机分组到采集样本的尿液采集时间在两组之间没有差异。
我们的研究未能表明使用 POCUS 提高刺激清洁尿采集成功率的益处。此外，应进一步评估清洁尿操作前喂养期的重要性。
NCT02751671。
