What is the recommended course of action for a patient with a hip fracture who did not have a Urinalysis (UA) ordered to rule out a Urinary Tract Infection (UTI)?

Management of Hip Fracture Patient Without Urinalysis

A urinalysis should be ordered promptly for a patient with hip fracture who did not have one initially, as urinary tract infections are common in this population and can impact patient outcomes. 1, 2

Rationale for Urinalysis in Hip Fracture Patients

• Hip fracture patients have a high prevalence of urinary tract infections:
  • Up to 29.2% may have a positive urine culture on admission 2
  • 7.7-23% develop nosocomial UTIs during hospitalization 2, 3
  • Diabetes is a significant risk factor, with diabetic patients showing particularly high rates of UTI 1

Recommended Protocol

1. Order urinalysis immediately:

   • Collect a sterile urine sample using proper technique
   • Send for culture and sensitivity testing
   • Do not delay surgery for this test, but ensure it's completed as part of initial workup

2. Monitor for UTI symptoms:

   • Fever
   • Altered mental status/confusion (common in hip fracture patients with UTI)
   • Suprapubic tenderness
   • Dysuria (if patient can report symptoms)

3. Catheter management:

   • Remove urinary catheters as soon as possible to reduce infection risk 4
   • If catheterization is necessary, prefer intermittent catheterization over indwelling catheters 5
   • Longer duration of catheter use significantly increases UTI risk 5

4. Treatment considerations:

   • If UTI is confirmed, initiate appropriate antibiotic therapy based on culture results
   • Consider local antibiotic resistance patterns when selecting empiric therapy
   • E. coli is the most common pathogen in this population 3

Prevention of UTI Complications

• Early mobilization (within 24 hours post-surgery) helps reduce UTI risk 2
• Maintain adequate hydration and encourage oral fluid intake when possible 4
• Implement nurse education on catheter protocols to reduce CAUTI incidence 6
• Monitor for postoperative cognitive dysfunction, which can be precipitated by UTI 4

Impact on Patient Outcomes

• UTIs can complicate recovery and rehabilitation
• May contribute to postoperative confusion and delirium
• Can potentially extend hospital stay
• Proper management reduces morbidity and improves rehabilitation potential

Obtaining a urinalysis is a simple but important step in comprehensive care for hip fracture patients that should not be overlooked, as early detection and treatment of UTIs can significantly impact recovery and prevent complications.