Female Gender and the Very Elderly: High Risk for Unnecessary Urinary Catheter Placement in the Emergency Department

Table: Multivariate Analysis of Factors Associated with UC Placement
	All UC Placed (Significance)	OR (95%CI)	UC Placed without an Indication (Significance)	OR (95%CI)
Model A: All Cases
Female Gender	<0.001	1.46 (1.21-1.76)	0.003	1.90 (1.25-2.89)
Emergency Medicine Resident Physician Care	<0.001	1.48 (1.23-1.78)	NS
Age  (Compared to 50 years or Younger)
Age 51 to 64 Years	NS		NS
Age 65 to 79 Years	0.003	1.49 (1.15-1.94)	NS
Age 80 Years and Older	<0.001	2.21 (1.73-2.81)	<0.001	2.86 (1.69-4.85)
Model B: Including Only those with a UC Placed With Physician Order
Female Gender	NS		0.008	2.08 (1.21-3.58)
Emergency Medicine Resident Physician care	<0.001	1.56 (1.23-1.97)	NS
Age  (Compared to 50 years or Younger)
Age 51 to 64 Years	NS		NS
Age 65 to 79 Years	0.01	1.53 (1.1-2.13)	NS
Age 80 Years or Older	<0.001	2.31 (1.71-3.14)	0.009	2.48 (1.25-4.93)
Model C: Including those that Had a UC Placed Without Physician Order
Female Gender	<0.001	2.05 (1.53-2.75)	NS
Emergency Medicine Resident Physician care	0.04	1.34 (1.02-1.75)	NS
Age  (Compared to 50 years or Younger)
Age 51 to 64 Years	NS		NS
Age 65 to 79 Years	NS		0.05	2.56 (1.03-6.38)
Age 80 years and Older	<0.001	2.12 (1.48-3.04)	0.004	3.41 (1.47-7.91)

Background: Large numbers of urinary catheters (UC) are placed in the Emergency Department (ED). This makes the ED an important area to address appropriate UC utilization. We recently found that about one-third of UCs placed in the ED were not indicated or did not have clear reasons for placement based on our institutional UC utilization guidelines.

Objective: To evaluate the compliance with indications for UC utilization and assess factors influencing utilization.

Methods: A 12 week evaluation of UC utilization of all admissions to the hospital from the ED. Data collected included the number of patients admitted, number of UC placed, reasons for placement, presence of a physician order for placement, care by emergency medicine resident physicians, patient age and gender.

Results: 4521 patients were admitted with 533 (11.8%) UC placed in the ED. Of these, 372 (69.8%) were indicated, and 312 (58.5%) had a physician order documented. The mean age of those who had a UC placed based on an indication was 60.1±22.4 years compared to 71.3±18.8 years of those with a UC placed without an indication (p<0.001). In addition, the mean age of those who had a UC placed without an indication was significantly different from those that did not have a UC placed (56.2±22.5 years, p<0.001). Finally, females were 2.6 times more likely to have a UC placed without an indication (n=120, 5.4%) compared to men (n=41, 2.1%) (p<0.001). Multivariate analysis showed that age 80 years and older and female gender were independent factors for unnecessary UC placement (table).

Conclusions: Very advanced age and female gender are significantly associated with unnecessary UC utilization in the ED. Further work is needed to evaluate factors leading to this practice.