Does perception of catheterization limit its use in pediatric UTI

Summary Introduction Urinary tract infections (UTIs) affect 3–8% of febrile children annually, but correctly diagnosing UTI in young children can present a challenge. Diagnosis requires a non-contaminated urine sample, which requires catheterization or suprapubic aspiration in infants and young children that have not completed toilet training. To improve adherence to these guidelines, it is critical to understand the barriers to urine testing and catheterization. Objective The purpose of this study was to investigate parental perception of pediatric UTI evaluation to better understand factors that impede urine testing prior to treatment of suspected UTI. Study design We conducted an electronic, cross-sectional survey via social media targeting parents of children with a history of UTI. Participants were queried regarding demographics, urine specimen collection method, factors influencing urine collection method, and perception of the experience. Multivariable logistic regression was used to assess factors associated with catheterization distress and urine testing. Results Of 2726 survey respondents, > 80% were female and White; 74% of the children with a history of UTI were female. Fifty-six percent of parents perceived extreme distress with catheterization. Among parents whose child was catheterized, extreme distress was less likely perceived if the parent was White (OR 0.6, 95% CI 0.4–0.9) or if the child was circumcised (OR 0.7, 95% CI 0.4–0.98). Among those whose child was not catheterized, extreme distress was more likely if parents had a college education (OR 3.2, 95% CI 2.2–4.5) and the child was more than 1 year old (OR 1.7, 95% CI 1.2–2.5). Catheterization was less likely to be withheld if parents had a college education (OR 0.1, 95% CI 0.1–0.2), and if the child was circumcised (OR 0.5, 95% CI 0.3–0.8) or had only one UTI (OR 0.6, 95% CI 0.4–0.8) (Table). Discussion Parental education level, child age, and circumcision status play an important role in the subjective distress associated with catheterization. This highlights the substantial impact of parental factors on adherence to guidelines for children suspected of UTI. For example, college-educated parents were more likely to be offered catheterization. However, these parents are also more likely to associate the catheterization experience with extreme distress, possibly limiting their likelihood of consent to this procedure. More studies are required to better understand the impact of these factors on catheterization. But, it is clear that parental input has a substantial impact on the evaluation of their child's suspected UTI. Table . Factors associated with not being catheterized among those whose child should have been offered catheterization based on age and lack of toilet training (A), and associated with parental perception of catheterization as “extreme distress” among those whose children were not catheterized (B). (A) Not offered catheterization ( n  = 396) (B) Extreme distress, not catheterized ( n  = 1051) Frequency, n (%) OR (95% CI) p Frequency, n (%) OR (95% CI) p Annual income (US$) 55 (14) – 220 (21) –  25,000–49,999 89 (22) 1.0 (0.63–1.57) 299 (28) 1.0 (0.76–1.34)  50,000–74,999 69 (17) 1.2 (0.73–2.04) 199 (19) 0.9 (0.68–1.32)  75,000–99,999 69 (17) 1.1 (0.66–1.85) 124 (12) 0.3 (0.22–0.42)  > 100,000 115 (29) 1.2 (0.69–2.05) 208 (20) 0.4 (0.27–0.54) Education  ≤ High school 72 (18) – 254 (24) –  Some college 140 (35) 0.9 (0.61–1.28) 531 (50) 1.0 (0.77–1.26)  ≥ College degree 185 (47) 0.1 (0.08–0.22) 267 (25) 3.2 (2.25–4.46) Ethnicity  Non-White 68 (17) – 205 (19) –  White 328 (83) 1.0 (0.66–1.38) 0.498 846 (81) 1.0 (0.81–1.32) 0.952 Sex  Female 278 (70) – 770 (73) –  Circumcised male 81 (20) 0.5 (0.32–0.76) 52 (5) 0.9 (0.73–1.21)  Not circumcised male 38 (10) 1.1 (0.62–1.88) 229 (22) 1.2 (0.74–1.79) 0.010 Number of UTIs  > 1 166 (42) – 625 (59) –  1 230 (58) 0.6 (0.42–0.78) 0.025 426 (41) 1.0 (0.69–1.38) 0.337