title: Does perception of catheterization limit its use in pediatric UTI?
abstract: BACKGROUND
  Urinary tract infections (UTIs) affect 3-8% of febrile children annually, but correctly diagnosing UTI in young children can present a challenge. Diagnosis requires a non-contaminated urine sample, which requires catheterization or suprapubic aspiration in infants and young children that have not completed toilet training. To improve adherence to these guidelines, it is critical to understand the barriers to urine testing and catheterization.
  
  
  OBJECTIVE
  The purpose of this study was to investigate parental perception of pediatric UTI evaluation to better understand factors that impede urine testing prior to treatment of suspected UTI.
  
  
  METHODS
  We conducted an electronic, cross-sectional survey via social media targeting parents of children with a history of UTI. Participants were queried regarding demographics, urine specimen collection method, factors influencing urine collection method, and perception of the experience. Multivariable logistic regression was used to assess factors associated with catheterization distress and urine testing.
  
  
  RESULTS
  Of 2726 survey respondents, > 80% were female and White; 74% of the children with a history of UTI were female. Fifty-six percent of parents perceived extreme distress with catheterization. Among parents whose child was catheterized, extreme distress was less likely perceived if the parent was White (OR 0.6, 95% CI 0.4-0.9) or if the child was circumcised (OR 0.7, 95% CI 0.4-0.98). Among those whose child was not catheterized, extreme distress was more likely if parents had a college education (OR 3.2, 95% CI 2.2-4.5) and the child was more than 1 year old (OR 1.7, 95% CI 1.2-2.5). Catheterization was less likely to be withheld if parents had a college education (OR 0.1, 95% CI 0.1-0.2), and if the child was circumcised (OR 0.5, 95% CI 0.3-0.8) or had only one UTI (OR 0.6, 95% CI 0.4-0.8) (Table).
  
  
  CONCLUSIONS
  Parental education level, child age, and circumcision status play an important role in the subjective distress associated with catheterization. This highlights the substantial impact of parental factors on adherence to guidelines for children suspected of UTI. For example, college-educated parents were more likely to be offered catheterization. However, these parents are also more likely to associate the catheterization experience with extreme distress, possibly limiting their likelihood of consent to this procedure. More studies are required to better understand the impact of these factors on catheterization. But, it is clear that parental input has a substantial impact on the evaluation of their child's suspected UTI.
authors.affiliation: Department of Urology, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Selekman
authors.affiliation: Department of Urology, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Melissa T
authors.initials: MT
authors.lastname: Sanford
authors.affiliation: Harvard Medical School, Boston, MA, USA.
authors.forename: Lauren N
authors.initials: LN
authors.lastname: Ko
authors.affiliation: Department of Urology, University of California, San Francisco, San Francisco, CA, USA; Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: I Elaine
authors.initials: IE
authors.lastname: Allen
authors.affiliation: Department of Urology, University of California, San Francisco, San Francisco, CA, USA. Electronic address: copphl@urology.ucsf.edu.
authors.forename: Hillary L
authors.initials: HL
authors.lastname: Copp
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use; D002140:California; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D016017:Odds Ratio; D010290:Parents / Q000523:psychology*; D010372:Pediatrics / Q000592:standards / Q000639:trends; D010465:Perception; D018570:Risk Assessment; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014546:Urinary Catheterization / Q000379:methods / Q000706:statistics & numerical data*; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*
chemical_list: D000890:Anti-Infective Agents
keywords: Antibiotics; Catheterization; Pediatrics; Urinary tract infections; Urine specimen collection