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

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).

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 seven days post-randomization and outcomes of death or disability (defined as "poor outcome," scores 3-6 on the modified Rankin scale) and any urinary tract infection at 90 days with adjustment of baseline and post-randomization management covariates.

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 urinary tract infection 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.

IUC use is associated with a poor outcome after acute stroke. Further studies are required to inform appropriate use of IUC.

International journal of stroke : official journal of the International Stroke Society. 2020 Feb 19 [Epub ahead of print]

Menglu Ouyang, Laurent Billot, Lili Song, Xia Wang, Christine Roffe, Hisatomi Arima, Pablo M Lavados, Maree L Hackett, Verónica V Olavarría, Paula Muñoz-Venturelli, Sandy Middleton, Octavio M Pontes-Neto, Tsong-Hai Lee, Caroline L Watkins, Thompson G Robinson, Craig S Anderson

The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia., Department of Neurosciences, Royal Stoke University Hospital, Stoke-on-Trent, UK., Departmento de Neurologia and Psiquiatria, Clínica Alemana de Santiago, Servicio de Neurología, Unidad de Neurología Vascular, Vitacura, Chile., Nursing Research Institute, St Vincent's Health Australia, Australian Catholic University, Sydney, Australia., Stroke Service-Neurology Division, Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirão Preto, Brazil., Stroke Center and Department of Neurology, Linkou Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan., Faculty of Health and Wellbeing, University of Central Lancashire, Preston, Lancashire, UK., Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK.