154: Risk Factors for Adverse Events Following Diagnostic Urethral Catheterization in the Pediatric Emergency Department

Abstract

Urethral catheterization (UC) is widely performed to diagnose urinary tract infection (UTI) in febrile young children presenting to the emergency department (ED). However, little is known about risk factors associated with adverse events following this procedure. To determine risk factors for adverse events following diagnostic UC in the pediatric ED. This was a secondary analysis of a prospective cohort study conducted over a period of nine months in a tertiary care pediatric ED. Recruitment mainly occurred during week days from 9AM until 7PM. All children aged three to 24 month old with fever ≥38°C (≥100.4°F) and who had a diagnostic UC were invited to participate. Parents were contacted by phone seven to 10 days following the ED visit to answer a standardized questionnaire about adverse events potentially related to the procedure. Adverse event was prospectively defined as painful urination, genital pain, urinary retention, hematuria or UTI occurring secondary to UC. No sample size was calculated a priori because it was a secondary analysis of another study. Nonetheless, it was estimated that 40 participants experiencing at least one complication permitted to evaluate five risk factors (male sex, age, previous UC, hematuria at UC, final diagnosis of UTI). Univariate and multivariate analysis were used to calculate odds ratio (OR). 240 patients were invited to participate. Among them, 219 patients accepted and were included in the study with 20 (9%) lost to follow-up. Of the 199 patients who completed the study, 110 were females (55%) and the median age was 10 months. Overall, 41 (21%) patients experienced at least one adverse event. Male sex (OR 3.99 [CI 1.84–8.61]) and age 12–23 months (OR 2.61 [CI 1.24–5.50]) were statistically associated to a higher risk of having adverse events. Urethral catheterization is associated to adverse events in the following week in 21% of young children. Male sex and age 12–23 months were associated with a higher risk of complications. It should be used carefully in young children especially in those with risk factors.