You Might Also Like

• Prediction Rule Identifies Febrile Infants at Low Risk for Serious Bacterial Infection
• Urine Tests Unreliable for Assessing Dehydration in Older Adults
• Evaluating Fever in Well-Appearing Infants and Children

Explore This Issue

ACEP Now: Vol 36 – No 12 – December 2017

(click for larger image) Table 1: Secondary Outcomes of Quick-Wee Versus Usual Care for Urine Collection in Infants

Reference

Kaufman K, Fitzpatrick P, Tosif S, et al. Faster clean catch urine collection (Quick-Wee method) from infants: randomised controlled trial. BMJ. 2017;357:j1341.

• Population: Infants age 1–12 months in whom a urine sample was required and the clinician felt the appropriate method of collection was a clean catch urine.
  • Exclusions: Neonates and infants with neurological or anatomical abnormalities affecting sensation or voiding.
• Intervention: Quick-Wee method: Genital area was cleansed for 10 seconds with sterile water at room temperature. This was followed by continued rubbing of the suprapubic area in a circular pattern with gauze soaked in cold saline. A parent/clinician stood by for up to five minutes, ready to catch the urine sample.
• Comparison: Usual care: Genital area was cleansed for 10 seconds with sterile water at room temperature with a parent/clinician standing by, ready to catch the urine sample.
• Outcomes:
  • Primary: Proportion of subjects voiding within five minutes.
  • Secondary: Voiding with successful catch of urine sample, rates of contamination, and parental/clinician satisfaction with technique on a 5-point Likert scale.

Authors’ Conclusion

“Quick-Wee is a simple cutaneous stimulation method that significantly increases the five-minute voiding rate and success rate of clean catch urine collection.”

Key Results

There were 170 in the control group and 174 in the intervention group, totalling 344 subjects. It was evenly split between male and female infants, with the mean age being 5.4 months. The most common clinical indication for urine collection was fever (42 percent), followed by unsettled baby (38 percent). Only 17 percent of infants had urine collected because a UTI was specifically suspected.

• Primary Outcome: Voiding within five minutes (31 percent Quick-Wee versus 12 percent with usual care); an absolute difference of 19 percent (95% CI, 11%–28%). Number needed to treat was five.
• Secondary Outcomes: See Table 1.

Evidence-Based Medicine Commentary

Selection Bias: There may have been some selection bias. It appears that the patients were identified and recruited by the same emergency department that did the intervention.

External Validity: This was a single center, tertiary pediatric hospital in Australia and may not represent the same pediatric population presenting to pediatric, community, or rural emergency departments in the United States. Also, note that they also excluded neonates and those older than 12 months of age.

Statistical Significance: The sample size was calculated with 80 percent power to detect a difference of 15 percent between groups in the primary outcome. They did find a 19 percent difference, but the lower end of the 95 percent confidence interval was 11 percent.