Mengdong He, Emily Hon, Lin Xu, Stephen Hampton, Kimberly Waddell
{"title":"量化成人脊髓损伤住院患者指南不一致的间歇导尿:一项回顾性队列研究。","authors":"Mengdong He, Emily Hon, Lin Xu, Stephen Hampton, Kimberly Waddell","doi":"10.1038/s41393-025-01078-w","DOIUrl":null,"url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objectives: </strong>To characterize guideline-discordant clean intermittent catheterization (CIC) during hospitalizations of patients with spinal cord injury (SCI), explore predictors of guideline-discordant CIC, and examine its association with urinary tract infection (UTI).</p><p><strong>Setting: </strong>Acute care hospitals within a large academic health system.</p><p><strong>Methods: </strong>Using electronic health records (9/1/2021-9/30/2023), we identified adults hospitalized with a discharge diagnosis of SCI and ≥1 documented CIC bladder output. The primary outcome was guideline-discordant CIC (bladder output volume >500 mL and/or time between CIC > 6 h). Generalized linear model and Chi-square test were used to evaluate patient factors and UTI risk associated with guideline-discordant CIC.</p><p><strong>Results: </strong>The study included 413 patients with SCI covering 8,016 CIC measurements during 519 hospitalizations. Their mean (SD) age was 55.2 (20.6) years, with 34.7% female and 46.8% Black. 52.8% were covered by Medicare. 79.4% had a thoracolumbar-level SCI. 50.2% of CICs were guideline-discordant. Males and those with managed care insurance had significantly higher odds of guideline-discordant CIC (OR = 1.34, 95% CI, 1.03 to 1.73 and OR = 2.05, 95% CI, 1.18 to 3.54, respectively). Patients with an indwelling catheter for ≥12 days before initiating CIC had significantly lower odds of guideline-discordant CIC (OR = 0.65, 95% CI, 0.49 to 0.84). The UTI incidence was 12.5% in hospitalizations with guideline-discordant CIC compared to 10.4% with guideline-concordant CIC (P = 0.49).</p><p><strong>Conclusions: </strong>Half of CICs did not adhere to guidelines, highlighting the need for quality improvement initiatives. Further research examining the association between UTI and CIC care patterns is warranted.</p>","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 5","pages":"270-276"},"PeriodicalIF":2.1000,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12074987/pdf/","citationCount":"0","resultStr":"{\"title\":\"Quantifying guideline-discordant intermittent catheterization in adults hospitalized with spinal cord injury: a retrospective cohort study.\",\"authors\":\"Mengdong He, Emily Hon, Lin Xu, Stephen Hampton, Kimberly Waddell\",\"doi\":\"10.1038/s41393-025-01078-w\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objectives: </strong>To characterize guideline-discordant clean intermittent catheterization (CIC) during hospitalizations of patients with spinal cord injury (SCI), explore predictors of guideline-discordant CIC, and examine its association with urinary tract infection (UTI).</p><p><strong>Setting: </strong>Acute care hospitals within a large academic health system.</p><p><strong>Methods: </strong>Using electronic health records (9/1/2021-9/30/2023), we identified adults hospitalized with a discharge diagnosis of SCI and ≥1 documented CIC bladder output. The primary outcome was guideline-discordant CIC (bladder output volume >500 mL and/or time between CIC > 6 h). Generalized linear model and Chi-square test were used to evaluate patient factors and UTI risk associated with guideline-discordant CIC.</p><p><strong>Results: </strong>The study included 413 patients with SCI covering 8,016 CIC measurements during 519 hospitalizations. Their mean (SD) age was 55.2 (20.6) years, with 34.7% female and 46.8% Black. 52.8% were covered by Medicare. 79.4% had a thoracolumbar-level SCI. 50.2% of CICs were guideline-discordant. Males and those with managed care insurance had significantly higher odds of guideline-discordant CIC (OR = 1.34, 95% CI, 1.03 to 1.73 and OR = 2.05, 95% CI, 1.18 to 3.54, respectively). Patients with an indwelling catheter for ≥12 days before initiating CIC had significantly lower odds of guideline-discordant CIC (OR = 0.65, 95% CI, 0.49 to 0.84). The UTI incidence was 12.5% in hospitalizations with guideline-discordant CIC compared to 10.4% with guideline-concordant CIC (P = 0.49).</p><p><strong>Conclusions: </strong>Half of CICs did not adhere to guidelines, highlighting the need for quality improvement initiatives. Further research examining the association between UTI and CIC care patterns is warranted.</p>\",\"PeriodicalId\":21976,\"journal\":{\"name\":\"Spinal cord\",\"volume\":\"63 5\",\"pages\":\"270-276\"},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2025-05-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12074987/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Spinal cord\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1038/s41393-025-01078-w\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/4/29 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Spinal cord","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1038/s41393-025-01078-w","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/4/29 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Quantifying guideline-discordant intermittent catheterization in adults hospitalized with spinal cord injury: a retrospective cohort study.
Study design: Retrospective cohort study.
Objectives: To characterize guideline-discordant clean intermittent catheterization (CIC) during hospitalizations of patients with spinal cord injury (SCI), explore predictors of guideline-discordant CIC, and examine its association with urinary tract infection (UTI).
Setting: Acute care hospitals within a large academic health system.
Methods: Using electronic health records (9/1/2021-9/30/2023), we identified adults hospitalized with a discharge diagnosis of SCI and ≥1 documented CIC bladder output. The primary outcome was guideline-discordant CIC (bladder output volume >500 mL and/or time between CIC > 6 h). Generalized linear model and Chi-square test were used to evaluate patient factors and UTI risk associated with guideline-discordant CIC.
Results: The study included 413 patients with SCI covering 8,016 CIC measurements during 519 hospitalizations. Their mean (SD) age was 55.2 (20.6) years, with 34.7% female and 46.8% Black. 52.8% were covered by Medicare. 79.4% had a thoracolumbar-level SCI. 50.2% of CICs were guideline-discordant. Males and those with managed care insurance had significantly higher odds of guideline-discordant CIC (OR = 1.34, 95% CI, 1.03 to 1.73 and OR = 2.05, 95% CI, 1.18 to 3.54, respectively). Patients with an indwelling catheter for ≥12 days before initiating CIC had significantly lower odds of guideline-discordant CIC (OR = 0.65, 95% CI, 0.49 to 0.84). The UTI incidence was 12.5% in hospitalizations with guideline-discordant CIC compared to 10.4% with guideline-concordant CIC (P = 0.49).
Conclusions: Half of CICs did not adhere to guidelines, highlighting the need for quality improvement initiatives. Further research examining the association between UTI and CIC care patterns is warranted.
期刊介绍:
Spinal Cord is a specialised, international journal that has been publishing spinal cord related manuscripts since 1963. It appears monthly, online and in print, and accepts contributions on spinal cord anatomy, physiology, management of injury and disease, and the quality of life and life circumstances of people with a spinal cord injury. Spinal Cord is multi-disciplinary and publishes contributions across the entire spectrum of research ranging from basic science to applied clinical research. It focuses on high quality original research, systematic reviews and narrative reviews.
Spinal Cord''s sister journal Spinal Cord Series and Cases: Clinical Management in Spinal Cord Disorders publishes high quality case reports, small case series, pilot and retrospective studies perspectives, Pulse survey articles, Point-couterpoint articles, correspondences and book reviews. It specialises in material that addresses all aspects of life for persons with spinal cord injuries or disorders. For more information, please see the aims and scope of Spinal Cord Series and Cases.