Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.
Arch Dis Child. 2020 Mar;105(3):253-259. doi: 10.1136/archdischild-2019-317561. Epub 2019 Aug 23.
Urinary tract infection (UTI) is a common childhood infection. Many febrile children require a urine sample to diagnose or exclude UTI. Collecting urine from young children can be time-consuming, unsuccessful or contaminated. Cost-effectiveness of each collection method in the emergency department is unknown.
To determine the cost-effectiveness of urine collection methods for precontinent children.
A cost-effectiveness analysis was conducted comparing non-invasive (urine bag, clean catch and 5 min voiding stimulation for clean catch) and invasive (catheterisation and suprapubic aspirate (SPA)) collection methods, for children aged 0-24 months in the emergency department. Costs included equipment, staff time and hospital bed occupancy. If initial collection attempts were unsuccessful subsequent collection using catheterisation was assumed. The final outcome was a definitive sample incorporating progressive dipstick, culture and contamination results. Average costs and outcomes were calculated for initial collection attempts and obtaining a definitive sample. One-way and probabilistic sensitivity analyses were performed.
For initial collection attempts, catheterisation had the lowest cost per successful collection (GBP£25.98) compared with SPA (£37.80), voiding stimulation (£41.32), clean catch (£52.84) and urine bag (£92.60). For definitive collection, catheterisation had the lowest cost per definitive sample (£49.39) compared with SPA (£51.84), voiding stimulation (£52.25), clean catch (£64.82) and urine bag (£112.28). Time occupying a hospital bed was the most significant determinant of cost.
Catheterisation is the most cost-effective urine collection method, and voiding stimulation is the most cost-effective non-invasive method. Urine bags are the most expensive method. Although clinical factors influence choice of method, considering cost-effectiveness for this common procedure has potential for significant aggregate savings.
尿路感染（UTI）是一种常见的儿童感染。许多发热的儿童需要采集尿液样本以诊断或排除 UTI。从幼儿中采集尿液可能既耗时、又不成功或受污染。在急诊科，每种采集方法的成本效益尚不清楚。
确定用于非憋尿儿童的尿液采集方法的成本效益。
通过成本效益分析比较了非侵入性（尿袋、清洁接取和 5 分钟排空刺激用于清洁接取）和侵入性（导尿和耻骨上抽吸（SPA））采集方法，适用于急诊科 0-24 个月的儿童。成本包括设备、员工时间和医院床位占用。如果初始采集尝试不成功，则假定使用导尿进行后续采集。最终结果是包含渐进式尿试纸、培养和污染结果的明确样本。计算了初始采集尝试和获得明确样本的平均成本和结果。进行了单因素和概率敏感性分析。
对于初始采集尝试，导尿术的每次成功采集成本最低（25.98 英镑），而 SPA（37.80 英镑）、排空刺激（41.32 英镑）、清洁接取（52.84 英镑）和尿袋（92.60 英镑）。对于明确采集，导尿术的每次明确样本采集成本最低（49.39 英镑），而 SPA（51.84 英镑）、排空刺激（52.25 英镑）、清洁接取（64.82 英镑）和尿袋（112.28 英镑）。占用医院床位的时间是成本的最重要决定因素。
导尿术是最具成本效益的尿液采集方法，而排空刺激是最具成本效益的非侵入性方法。尿袋是最昂贵的方法。尽管临床因素会影响方法的选择，但考虑到这种常见程序的成本效益，可能会有显著的总体节省。
