Mengdong He, MHS
Medical Student
UCLA David Geffen School of Medicine
Los Angeles, California, United States
Emily Hon, MD
Resident Physician
Department of Physical Medicine and Rehabilitation, University of Pennsylvania
Philadelphia, Pennsylvania, United States
Lin Xu, MS
Researcher
Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania
Philadelphia, Pennsylvania, United States
Stephen Hampton, MD
Assistant Professor of Physical Medicine and Rehabilitation
Department of Physical Medicine and Rehabilitation, University of Pennsylvania
Philadelphia, Pennsylvania, United States
Kimberly J. Waddell, PhD, MSCI
Assistant Professor of Physical Medicine and Rehabilitation
Department of Physical Medicine and Rehabilitation, University of Pennsylvania
Philadelphia, Pennsylvania, United States
We conducted a retrospective cohort study using electronic medical records from a large academic health system between September 2021-September 2023. Study participants were adult patients hospitalized with a discharge diagnosis of SCI and ≥1 documented CIC bladder output. The primary outcome was guideline-discordant CIC, defined as bladder output volume >500 mL or time between CIC >6 hours. Generalized linear model and Chi-square tests 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 hospital admissions. The mean (SD) age was 55.2 (20.6) years, with 34.7% female and 46.8% Black race. Medicare and Medicaid were the most common insurance types (52.8% and 28.9%, respectively). The majority had a thoracolumbar-level SCI (79.4%). Across all CIC measurements, 50.2% met criteria for guideline discordance. Males and those with managed care insurance had significantly higher odds of guideline-discordant CIC (OR=1.34, 95% CI: 1.03-1.73 and OR=2.05, 95% CI: 1.18-3.54, 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: 0.49-0.84). The incidence of UTI was 12.5% in hospitalizations with guideline-discordant CIC versus 10.4% with guideline-concordant CIC (P=0.49).
Conclusions:
One-half of CICs did not adhere to guidelines. This provides critical baseline data to support quality improvement initiatives to promote guideline-concordant CIC during acute hospitalization for SCI. Although our study did not find an increased UTI incidence associated with varied CIC care patterns, further research including confounding adjustment is warranted.
