• Patricia Eiroa-Hernández, Sebastián Matos, Sira Aguiló, Aitor Alquézar-Arbé, Javier Jacob, Cesáreo Fernández, Pere Llorens, Sandra Moreno Ruíz, Lidia Cuevas Jiménez, Aarati Vaswani-Bulchand, Montserrat Rodríguez-Cabrera, Maribel Coromoto Suárez Pineda, Sara Alegre Fresno, Ivet Gina Osorio, Ana María Puche Alcaraz, Jésica Mansilla Collado, Mónica Veguillas Benito, Francisco Chamorro, Lorenzo Álvarez Rocío, Valle Toro Gallardo, Fahd Beddar Chaib, Jorge Pedraza García, Francisco de Borja Quero Espinosa, Montserrat Jiménez Lucena, Gabriel Yepez León, Enrique González Revuelta, Sara Sánchez Aroca, Juan González Del Castillo, Guillermo Burillo-Putze, Òscar Miró, and Investigadores de la red SIESTA.
• Servicio de Urgencias, Hospital Universitario de Canarias, Tenerife, España. Universidad de La Laguna, Tenerife, España.
• Emergencias. 2023 Dec 1; 35 (6): 415422415-422.

ObjectivesThe 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.Material And MethodsIncluded 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.ResultsParticipating 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).ConclusionCertain 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.

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