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Master Thesis

Analyse de la méthode de drainage urinaire chez les blessés médullaires, à la phase aigüe du traumatisme, de 2013 à 2018 au CHU de Bordeaux : parcours de soin et morbidité

Abstract : Background: spinal cord injury (SCI) due to loss of integrity of the nervous system have neurological bladders. Bladder drainage is necessary to protect the upper urinary tract and limit the risk of infection. International learned societies recommend early intermittent catheterization (IC) to limit urologic complications, preserve fertility, prepare the urological future and improve quality of life. The objective of our study was to observe the mode of urinary drainage in BM at the acute period of trauma and the impact on morbidity. Methods: we retrospectively analyzed the bladder draining patterns performed in the SCI with bladder-sphincteric disorders at the acute period of the trauma at the Bordeaux University Hospital from January 2013 to December 2017. The data collected related to the characteristics of the patients, the lengths of hospitalization, the drainage methods used, the early complications, the orientation at the exit of the Bordeaux hospital, the ECBU performed, the implementation of antibiotic therapy. It is an observational descriptive study that used medians, means, and standard deviation. To complete it, a univariate analysis was conducted to determine the impact of the indwelling catheter (SAD) on the morbidity and use of antibiotics. Results: the course of care of 81 patients was analyzed. Total mean hospitalization times in intensive care unit and orthopedics were 38 days, 32 days, 18 days, respectively. The percentage of patients who left the hospital with a SAD after treatment in the intensive care unit, in the orthopedic department or initially in the intensive care unit and then orthopedics was 25.5%, 87.5% and 90,3% respectively. The percentage of patients who presented at least one event (IU, SAD bites, urinary leakage, pain, trauma or hematuria macroscopic) on SAD were 40.7% of which 45.5% who presented a febrile IU. The percentage of patients with IC who presented an event was 24.4% of whom 20% had a febrile IU. A total of 169 ECBUs were performed including 136 in intensive care and 33 in orthopedics. SAD was significantly associated with a higher risk of febrile IU (p = 0.047), non-febrile IU (p = 0.032) and antibiotic use with (p <0.001). A SAD Exposition greater than or equal to 30 days was significantly associated with a risk of febrile IU (p = 0.017), non-febrile IU (p = 0.01) and antibiotic use (p <0.001). Conclusion: the precosed beginning of IC is not always initiated despite recommendations. This has a direct impact on BM morbidity as early as the acute period of trauma. This work is the beginning of a research study in care whose purpose will be to promote intermittent catheterization in this population.
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https://dumas.ccsd.cnrs.fr/dumas-02493450
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Hélène Siméon. Analyse de la méthode de drainage urinaire chez les blessés médullaires, à la phase aigüe du traumatisme, de 2013 à 2018 au CHU de Bordeaux : parcours de soin et morbidité. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02493450⟩

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