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Practice variation in urine collection methods among pre-toilet trained children with suspected urinary tract
Lucy M Wilson1,2,3, Clara Tam1, Veronica Ka Wai Lai1,4
1Children's Hospital Research Institute of Manitoba, University of Manitoba, 715 McDermot Ave., Winnipeg, MB, R3E 3P4, Canada.
Insights
Novel urine collection methods improve healthcare outcomes for diagnosing urinary tract infections (UTIs) in infants and young children. This systematic review highlights practice variations and provider preferences for these advanced techniques.
Area of Science:
- Pediatrics
- Infectious Diseases
- Urology
Background:
- Urinary tract infections (UTIs) are a frequent cause of acute illness in young children.
- Effective urine collection is crucial for UTI diagnosis in non-toilet-trained infants and children.
- Significant practice variation exists in current urine collection methods.
Purpose of the Study:
- To examine practice variations in urine collection methods for diagnosing UTIs in non-toilet-trained children.
- To compare the effectiveness and outcomes of different urine collection techniques.
- To assess healthcare provider satisfaction with various urine collection methods.
Main Methods:
- Systematic review of studies published from 2000 to 2023.
- Searched multiple databases including MEDLINE, Embase, and CINAHL.
- Included studies comparing urine collection methods in acute care facilities for pre-toilet-trained children, assessing health outcomes and provider satisfaction.
Main Results:
- Eight studies involving 728 children were included.
- Seven studies indicated improved healthcare outcomes with novel urine collection methods compared to conventional ones.
- Novel methods, such as ultrasound guidance, showed promise, and providers expressed preference for them.
Conclusions:
- Substantial practice variation exists globally in urine collection methods for pediatric UTI diagnosis.
- Further research is required to understand clinician practice variations and guideline adherence.
- Novel methods demonstrate potential for improved outcomes and provider satisfaction.
Background:
Urinary tract infections (UTIs) are a common cause of acute illness among infants and young children. There are numerous methods for collecting urine in children who are not toilet trained. This review examined practice variation in the urine collection methods for diagnosing UTI in non-toilet-trained children.
Methods:
A systematic review was completed by searching MEDLINE (Ovid), Embase (Ovid), CENTRAL (Ovid), PsycInfo (Ovid), CINAHL (EBSCO), and JBI (Ovid) from January 1, 2000 until October 9, 2021 and updated on May 24, 2023. Studies were included if they were conducted in an acute care facility, examined pre-toilet trained children, and compared one urine collection method with another for relevant health care outcomes (such as length of stay in an ED, or re-visits or readmissions to the ED) or provider satisfaction. Two independent reviewers screened the identified articles independently, and those included in the final analysis were assessed for quality and bias using the Newcastle-Ottawa Scale.
Results:
Overall, 2535 articles were reviewed and 8 studies with a total of 728 children were included in the final analysis. Seven studies investigated the primary outcome of interest, practice variation in urine collection methods to diagnose a UTI. The seven studies that investigated novel methods of urine collection concluded that there were improved health care outcomes compared to conventional methods. Novel methods include emerging methods that are not captured yet captured in clinical practice guidelines including the use of ultrasound guidance to aid existing techniques. Three studies which investigated healthcare provider satisfaction found preference to novel methods of urine collection.
Conclusions:
There is significant practice variation in the urine collection methods within and between countries. Further research is needed to better examine practice variation among clinicians and adherence to national organizations and societies guidelines. PROSPERO registration number CRD42021267754.
