Factors related to bladder catheterization in older patients and its possible association with prognosis: results of the EDEN-30 study
Patricia Eiroa-Hernández1,2, Sebastián Matos3, Sira Aguiló4, Aitor Alquézar-Arbé5, Javier Jacob6, Cesáreo Fernández7, Pere Llorens8, Sandra Moreno Ruíz9, Lidia Cuevas Jiménez10, Aarati Vaswani-Bulchand11, Montserrat Rodríguez-Cabrera11, Maribel Coromoto Suárez Pineda12, Sara Alegre Fresno13, Ivet Gina Osorio4, Ana María Puche Alcaraz14, Jésica Mansilla Collado15, Mónica Veguillas Benito8, Francisco Chamorro6, Lorenzo Álvarez Rocío16, Valle Toro Gallardo17, Fahd Beddar Chaib18, Jorge Pedraza García19, Francisco de Borja Quero Espinosa20, Montserrat Jiménez Lucena21, Gabriel Yepez León22, Enrique González Revuelta23, Sara Sánchez Aroca24, Juan González del Castillo7, Guillermo Burillo-Putze3, Òscar Miró4 (en representación de los investigadores de la red SIESTA)
Affiliation of the authors
1Servicio de Urgencias, Hospital Universitario de Canarias, Tenerife, Spain. 2Universidad de La Laguna, Tenerife, Spain. 3Facultad de Ciencias de la Salud, Universidad Europea de Canarias, Tenerife, Spain. 4Área de Urgencias, Hospital Clínico, IDIBAPS, Universidad de Barcelona, Barcelona, Spain.5Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. 6Servicio de Urgencias, Hospital Universitario de Bellvitge, l’Hospitalet de Llobregat, Barcelona, Spain.7Servicio de Urgencias, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain. 8Servicio de Urgencias, Unidad de Estancia Corta y Hospitalización a Domicilio, Hospital Doctor Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain. 9Servicio de Urgencias, Hospital Universitario Infanta Cristina, Parla, Spain. 10Servicio de Urgencias, Hospital Santa Tecla, Tarragona, Spain. 11Servicio de Urgencias, Hospital del Norte de Tenerife, Spain. 12Servicio de Urgencias, Hospital General Universitario Reina Sofia, Murcia, Spain. 13Servicio de Urgencias, Hospital Universitario del Henares, Madrid, Spain. 14Servicio de Urgencias, Hospital General Universitario de Elche, Spain. 15Servicio de Urgencias, Hospital Universitario y Politécnico La Fe, Valencia, Spain. 16Servicio de Urgencias, Hospital de la Axiarquia de Velez-Malaga, Málaga, Spain. 17Servicio de Urgencias, Hospital Regional de Málaga, Málaga, Spain. 18Servicio de Urgencias, Hospital Santa Barbara, Soria, Spain. 19Servicio de Urgencias, Hospital Valle Pedroches. Pozoblanco, Córdoba, Spain. 20Servicio de Urgencias, Hospital Reina Sofia, Córdoba, Spain. 21Servicio de Urgencias, Hospital Universitario Gregorio Marañón, Madrid, Spain. 22Servicio de Urgencias, Hospital Universitario de Burgos, Burgos, Spain. 23Servicio de Urgencias, Complejo Asistencial Universitario de León, León, Spain. 24Servicio de Urgencias, Hospital Universitario Morales Meseguer, Murcia, Spain.
Eiroa-Hernández P, Matos S, Aguiló S, Alquézar-Arbé A, Jacob J, Fernández C, et al. Factors related to bladder catheterization in older patients and its possible association with prognosis: results of the EDEN-30 study. Emergencias. 2023;35:415-22
Summary
Objectives.
The aims of this study in the Emergency Department and Elder Needs (EDEN) series were to explore associations between clinical variables on arrival at the ED (baseline) and the insertion of a bladder catheter, and the relation between catheterization and deterioration to a more complex or serious clinical state.
Methods.
Included were all patients aged 65 years or older attended during 1 week in 52 Spanish EDs. Patients were grouped according to whether a bladder catheter was or was not inserted in the ED. We used multivariable logistical regression to explore associations between catheterization and patient age, sex, 10 comorbidities, 7 baseline status variables, and 6 clinical variables. Progression was considered serious or complex if the patient died or required hospitalization, a prolonged hospital stay, or discharge to a care facility. We also explored the association between age and catheterization using adjusted restricted cubic spline (RCS) curves with a cutoff value of 65 years.
Results.
Participating hospitals enrolled 24 573 patients; bladder catheters were inserted in 976 (4%). Of these, 44.3% were discharged from the ED. Fifteen of the 24 variables were independently associated with bladder catheterization. Factors with the strongest associations according to odds ratios (ORs) were impaired consciousness (OR, 2.50; 95% CI, 1.90-3.30), dehydration (OR, 2.24; 95% CI, 1.85-2.72), and male sex (OR, 2.12; 95% CI, 1.84-2.44). Age 80 years or older was also associated with bladder catheterization (OR, 1.17; 95% CI, 1.01-1.358). The adjusted RCS curves showed a progressive linear increase in the probability of catheterization with age. The increase was constant in men and stabilized after the age of 85 years in women (P-interaction < .001). Bladder catheterization was associated with hospitalization (OR, 2.31; 95% CI, 1.99-2.68), intensive care unit admission (OR, 4.64; 95% CI, 3.04-7.09), prolonged stay in the ED for discharged patients (OR, 2.28; 95% CI, 1.75-2.96), in-hospital death (OR, 1.99; 95% CI, 1.54-2.57), and 30-day death (OR, 1.66; 95% CI, 1.33-2.08). No associations were found between catheterization and prolonged hospital stay (OR, 1.11; 95% CI, 0.92-1.34) or need for a care facility on discharge (OR, 1.50; 95% CI, 0.98-2.29).
Conclusions.
Certain patient characteristics and baseline clinical conditions are associated with bladder catheterization in patients of advanced age. The main factors were decreased consciousness, dehydration, and male sex. Even after adjustment for related factors, catheterization is independently associated with progression to more complex or serious clinical states.
