title: Urinary catheter use and appropriateness in U.S. emergency departments, 1995-2010.
abstract: OBJECTIVE
  Catheter-associated urinary tract infection (CAUTI) is the most prevalent hospital-acquired infection, yet little is known about emergency department (ED) use of urinary catheters. The objective was to describe use of urinary catheters in U.S. EDs and determine the proportion that was potentially avoidable.
  
  
  METHODS
  The National Hospital Ambulatory Medical Care Survey (NHAMCS), a weighted probability sample of U.S. ED visits, was analyzed from 1995 through 2010 for use of urinary catheters in adults. Use of a urinary catheter was a specific chart review element and was classified as potentially avoidable if none of the Centers for Disease Control and Prevention (CDC) list of appropriate indications were met by ED visit diagnoses or patient disposition. Annual frequency of urinary catheter use and appropriateness were calculated. Predictors of ED-placed urinary catheters for admitted patients were assessed with multivariate logistic regression.
  
  
  RESULTS
  The annual rate of ED-placed urinary catheters varied from 2.2 to 3.3 per 100 adult ED visits. Among admitted patients, 8.5% (95% confidence interval [CI] = 8.0% to 9.1%) received urinary catheters; 64.9% (95% CI = 56.9% to 72.9%) were potentially avoidable. Among discharged patients 1.6% (95% CI = 1.5% to 1.7%) received urinary catheters. There was no significant trend over time in the use of urinary catheters or potentially avoidable urinary catheters (PAUCs). Predictors of catheter use in admitted patients included indicators of patient severity, female sex, and race/ethnicity. Hospital characteristics predicting catheter use included region, ownership type, and urban location. Predictors of potentially avoidable urinary catheter use were lower patient severity, female sex, care by a midlevel practitioner, and nonurban location.
  
  
  CONCLUSIONS
  Reducing use of urinary catheters outside of CDC guideline criteria in ED patients is a promising strategy to reduce CAUTIs.
authors.affiliation: The Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA; The Department of Medicine (Emergency), Harvard Medical School, Boston, MA.
authors.forename: Jeremiah D
authors.initials: JD
authors.lastname: Schuur
authors.forename: Jennifer Gibson
authors.initials: JG
authors.lastname: Chambers
authors.forename: Peter C
authors.initials: PC
authors.lastname: Hou
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055499:Catheter-Related Infections / Q000517:prevention & control; D016001:Confidence Intervals; D003428:Cross Infection / Q000517:prevention & control; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008875:Middle Aged; D014481:United States; D014546:Urinary Catheterization / Q000009:adverse effects / Q000706:statistics & numerical data*; D062885:Urinary Catheters; D055815:Young Adult