Prognostic significance of early urinary catheterization after acute stroke: Secondary analyses of the international HeadPoST trial
Journal
International Journal of Stroke
ISSN
1747-4930
1747-4949
Date Issued
2020
Author(s)
Menglu Ouyang
Laurent Billot
Lili Song
Xia Wang
Christine Roffe
Hisatomi Arima
Maree L Hackett
Sandy Middleton
Octavio M Pontes-Neto
Tsong-Hai Lee
Caroline L Watkins
Thompson G Robinson
Craig S Anderson
Type
Resource Types::text::journal::journal article
URL Institutional Repository
Abstract
<jats:sec><jats:title>Background</jats:title><jats:p> An indwelling urinary catheter (IUC) is often inserted to manage bladder dysfunction, but its impact on prognosis is uncertain. We aimed to determine the association of IUC use on clinical outcomes after acute stroke in the international, multi-center, cluster crossover, Head Positioning in Acute Stroke Trial (HeadPoST). </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> Data were analyzed on HeadPoST participants (n = 11,093) randomly allocated to the lying-flat or sitting-up head position. Binomial, logistic regression, hierarchical mixed models were used to determine associations of early insertion of IUC within seven days post-randomization and outcomes of death or disability (defined as “poor outcome,” scores 3–6 on the modified Rankin scale) and any urinary tract infection at 90 days with adjustment of baseline and post-randomization management covariates. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Overall, 1167 (12%) patients had an IUC, but the frequency and duration of use varied widely across patients in different regions. IUC use was more frequent in older patients, and those with vascular comorbidity, greater initial neurological impairment (on the National Institutes of Health Stroke Scale), and intracerebral hemorrhage as the underlying stroke type. IUC use was independently associated with poor outcome (adjusted odds ratio (aOR): 1.40, 95% confidence interval (CI): 1.13–1.74), but not with urinary tract infection after adjustment for antibiotic treatment and stroke severity at hospital separation (aOR: 1.13, 95% CI: 0.59–2.18). The number exposed to IUC for poor outcome was 13. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> IUC use is associated with a poor outcome after acute stroke. Further studies are required to inform appropriate use of IUC. </jats:p></jats:sec>
Cite this document
Ouyang, M., Billot, L., Song, L., Wang, X., Roffe, C., Arima, H., Lavados, P. M., Hackett, M. L., Olavarría, V. V., Muñoz-Venturelli, P., Middleton, S., Pontes-Neto, O. M., Lee, T.-H., Watkins, C. L., Robinson, T. G., & Anderson, C. S. (2021). Prognostic significance of early urinary catheterization after acute stroke: Secondary analyses of the international HeadPoST trial. International Journal of Stroke, 16(2), 200-206. https://doi.org/10.1177/1747493020908140
Subjects
urinary catheter
;
disability
;
acute stroke
;
urinary tract infection
;
clinical trial
;
aged
;
catheters, indwelling
;
cerebral hemorrhage
;
humans
;
prognosis
;
stroke
;
urinary catheterization
;
antibiotic agent
;
aged
;
article
;
bladder catheterization
;
brain hemorrhage
;
cerebrovascular accident
;
clinical outcome
;
comorbidity
;
controlled study
;
crossover procedure
;
death
;
disability
;
disease duration
;
female
;
head position
;
human
;
major clinical study
;
male
;
multicenter study
;
priority journal
;
prognosis
;
rankin scale
;
secondary analysis
;
sitting
;
urinary tract infection
;
cerebrovascular accident
;
complication
;
indwelling catheter
;
prognosis