Faster clean catch urine collection (Quick-Wee method) from infants: randomised controlled trial
BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1341 (Published 07 April 2017) Cite this as: BMJ 2017;357:j1341
- Jonathan Kaufman, paediatric trainee1 2 3,
- Patrick Fitzpatrick, paediatrician1 2,
- Shidan Tosif, paediatrician1 2 3,
- Sandy M Hopper, paediatric emergency physician1 2,
- Susan M Donath, associate professor2 3,
- Penelope A Bryant, associate professor1 2 3,
- Franz E Babl, associate professor1 2 3
- 1Royal Children’s Hospital, Parkville, Victoria, Australia
- 2Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- 3Department of Paediatrics, Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
- Correspondence to: F E Babl Murdoch Children’s Research Institute, Parkville, Victoria 3052, Australia franz.babl{at}rch.org.au
- Accepted 10 March 2017
Abstract
Objective To determine if a simple stimulation method increases the rate of infant voiding for clean catch urine within five minutes.
Design Randomised controlled trial.
Setting Emergency department of a tertiary paediatric hospital, Australia.
Participants 354 infants (aged 1-12 months) requiring urine sample collection as determined by the treating clinician. 10 infants were subsequently excluded.
Interventions Infants were randomised to either gentle suprapubic cutaneous stimulation (n=174) using gauze soaked in cold fluid (the Quick-Wee method) or standard clean catch urine with no additional stimulation (n=170), for five minutes.
Main outcome measures The primary outcome was voiding of urine within five minutes. Secondary outcomes were successful collection of a urine sample, contamination rate, and parental and clinician satisfaction with the method.
Results The Quick-Wee method resulted in a significantly higher rate of voiding within five minutes compared with standard clean catch urine (31% v 12%, P<0.001), difference in proportions 19% favouring Quick-Wee (95% confidence interval for difference 11% to 28%). Quick-Wee had a higher rate of successful urine sample collection (30% v 9%, P<0.001) and greater parental and clinician satisfaction (median 2 v 3 on a 5 point Likert scale, P<0.001). The difference in contamination between Quick-Wee and standard clean catch urine was not significant (27% v 45%, P=0.29). The number needed to treat was 4.7 (95% confidence interval 3.4 to 7.7) to successfully collect one additional urine sample within five minutes using Quick-Wee compared with standard clean catch urine.
Conclusions Quick-Wee is a simple cutaneous stimulation method that significantly increases the five minute voiding and success rate of clean catch urine collection.
Trial registration Australian New Zealand Clinical Trials Registry ACTRN12615000754549.
Footnotes
We thank the families and clinical staff participating in this trial. The Murdoch Children’s Research Institute and the Melbourne Children’s Trial Centre assisted with the study design, data management, and analysis and interpretation of data for this study. Staff from the emergency department of the Royal Children’s Hospital assisted with participant recruitment.
Contributors: PAB and FEB are joint senior authors. JK had the original idea for the study, and all authors contributed to the trial design and plan. JK and FEB were responsible for obtaining trial funding. JK, PF, ST, SH, and FB were responsible for supervising the study and data acquisition in the emergency department. JK and SMD carried out the statistical analysis. JK drafted the manuscript, which was revised by all authors. JK and FEB are guarantors.
Funding: This study was funded by a philanthropic research project grant from the Shepherd Foundation. The foundation was independent of this trial and its researchers and had no part in the study design, data collection, data interpretation and analysis, writing of the manuscript, or decision to submit the manuscript for publication. JK has been part funded by an Avant doctor in training research scholarship and Royal Australasian College of Physicians Basser research entry scholarship. FEB is supported in part by a National Health and Medical Research Council Centre of Excellence research grant for paediatric emergency medicine (GNT 1058560) and a Royal Children’s Hospital foundation grant, Melbourne Australia. The Royal Children’s Hospital Melbourne receives infrastructure support from the Victorian government’s infrastructure support programme, Melbourne, Australia.
Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: the trial was supported by a philanthropic research grant from the Shepherd Foundation; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.
Ethical approval: The study protocol (HREC reference 35083A) was approved by the Royal Children’s Hospital human research ethics committee. All participants gave informed consent.
Data sharing: No additional data available.
Transparency: The manuscript’s guarantors (JK and FEB) affirm that the manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and if relevant, registered) have been explained.
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