# Quantifying guideline-discordant intermittent catheterization in adults hospitalized with spinal cord injury: a retrospective cohort study

## TL;DR

This study found that nearly half of clean intermittent catheterizations in spinal cord injury patients during hospital stays did not follow guidelines, but no significant link to urinary tract infections was found.

## Contribution

The study quantifies guideline-discordant catheterization practices in SCI patients and identifies demographic and clinical predictors.

## Key findings

- 50.2% of clean intermittent catheterizations did not follow clinical guidelines.
- Male patients and those with managed care insurance had higher odds of guideline-discordant CIC.
- UTI incidence was not significantly different between guideline-discordant and concordant CIC practices.

## Abstract

Retrospective cohort study.

To characterize guideline-discordant clean intermittent catheterization (CIC) during hospitalizations of patients with spinal cord injury (SCI), explore predictors of guideline-discordant CIC, and examine its association with urinary tract infection (UTI).

Acute care hospitals within a large academic health system.

Using electronic health records (9/1/2021-9/30/2023), we identified adults hospitalized with a discharge diagnosis of SCI and ≥1 documented CIC bladder output. The primary outcome was guideline-discordant CIC (bladder output volume >500 mL and/or time between CIC > 6 h). Generalized linear model and Chi-square test were used to evaluate patient factors and UTI risk associated with guideline-discordant CIC.

The study included 413 patients with SCI covering 8,016 CIC measurements during 519 hospitalizations. Their mean (SD) age was 55.2 (20.6) years, with 34.7% female and 46.8% Black. 52.8% were covered by Medicare. 79.4% had a thoracolumbar-level SCI. 50.2% of CICs were guideline-discordant. Males and those with managed care insurance had significantly higher odds of guideline-discordant CIC (OR = 1.34, 95% CI, 1.03 to 1.73 and OR = 2.05, 95% CI, 1.18 to 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 to 0.84). The UTI incidence was 12.5% in hospitalizations with guideline-discordant CIC compared to 10.4% with guideline-concordant CIC (P = 0.49).

Half of CICs did not adhere to guidelines, highlighting the need for quality improvement initiatives. Further research examining the association between UTI and CIC care patterns is warranted.