Prognostic significance of early urinary catheterization after acute stroke: Secondary analyses of the international HeadPoST trial

Abstract

Total Word Count: 4173 (Abstract 244; Main 2083) 2 Brief title: Urinary catheterization and stroke outcome Abstract Background: 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). Methods: 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 7 days postrandomization and outcomes of death or disability (defined as 'poor outcome', scores 3-6 on the modified Rankin scale) and any urinary tract infection (UTI) at 90 days with adjustment of baseline and post-randomization management covariates.Results: 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 UTI 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.Conclusions: IUC use is associated with a poor outcome after acute stroke. Further studies are required to inform appropriate use of IUC.

Effectiveness and safety of a program for appropriate urinary catheter use in stroke care: A multicenter prospective study

“…"No instruction for IUC removal from physicians" was also recorded in 25 of the 56 days. Previous studies showed that IUC use is associated with poor functional outcomes and high mortality after acute stroke, [5][6][7] and suggested the need for further research on appropriate IUC use. 5,6 Few studies have reported on measures to reduce IUC use among stroke patients.…”

“…Previous studies showed that IUC use is associated with poor functional outcomes and high mortality after acute stroke, [5][6][7] and suggested the need for further research on appropriate IUC use. 5,6 Few studies have reported on measures to reduce IUC use among stroke patients. In this regard, two previous studies in neuro-ICU are informative, albeit the use of a single centre, incremental and adaptive feedback design.…”

“…Patients with stroke often receive IUC placement due to immobility, impaired consciousness or bladder dysfunction 4 . Between 12% and 31% of acute stroke patients received IUC placement during hospitalization in previous studies 5‐7 . As stroke‐induced immunosuppression increases the risk of post‐stroke infections, 8 stroke patients with IUC are susceptible to CAUTI.…”

“…As stroke‐induced immunosuppression increases the risk of post‐stroke infections, 8 stroke patients with IUC are susceptible to CAUTI. Moreover, urinary tract infection (UTI) 4,9 and IUC use itself 5‐7 are associated with worse outcomes in stroke patients.…”

Global stroke challenges: From COVID-19 to intracerebral hemorrhage and atrial fibrillation

“…This is illustrated in this issue by secondary analysis of the HeadPoST trial. 5 This trial was designed to assess positioning following stroke. However, the authors also analyzed associations between an indwelling urinary catheter and outcome.…”