Cheng‑Lun Hsiaoa,b, Wan‑Ling Changa, Pei‑Ya Chena,b, Shinn‑Kuang Lina,b*
aStroke Center and Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan, bSchool of Medicine, Tzu Chi University, Hualien, Taiwan
Open Access funded by Buddhist Compassion Relief Tzu Chi Foundation
Abstract
Objectives: We investigated the benefits of bladder point‑of‑care ultrasound (POCUS) during acute ischemic stroke (AIS) by applying AGN3 criteria. Materials and Methods: Three groups of inpatients with AIS were retrospectively enrolled. Group A (between January 2011 and March 2014) comprised 1104 patients who did not undergo bladder POCUS. Group B (between May 2014 and February 2017) comprised 824 patients for whom relaxed bladder POCUS criteria were applied. Group C (between July 2021 and October 2023) comprised 920 patients for whom AGN3 criteria were applied (i.e., age ≥75 years, female gender, National Institutes of Health Stroke Scale [NIHSS] total score ≥5, NIHSS conscious score ≥1, and NIHSS leg score ≥2). Results: The proportions of patients who met the AGN3 criteria were 76%, 73%, and 72% in Groups A, B, and C, respectively. Only 33% of Group B and 50% of Group C patients who met the AGN3 criteria underwent bladder POCUS. The incidence of urinary tract infection (UTI) was highest in Group A (6.9%), followed by Groups B (4%) and C (2.1%). The optimal cutoff postvoid residual urine volume for predicting UTI was ≥100 mL. The hospital length of stay (LOS) was longer in Group A (13.6 days) than in Groups B and C (11.9 and 12.1 days, respectively). A C‑statistic of 0.814 was estimated using the AGN3 criteria. AGN3 score ≥2 was the optimal cutoff value for predicting UTI. Conclusion: Bladder POCUS is beneficial for reducing the incidence of UTI and shortening hospital LOS. Patients with AGN3 score ≥2 were at higher risk of UTI and required bladder POCUS studies.
Keywords: Acute ischemic stroke, Bladder ultrasound, Length of stay, Point‑of‑care ultrasound, Urinary tract infection
