Scholarship winner to lead trial of novel ‘Quick-Wee’ urine collection method in children

By: Avant Media

Mar 14, 2016

Urinary tract infections are common in young children and if untreated can lead to permanent renal scarring, meningitis and severe sepsis. Urine samples are required to diagnose or exclude infections, however collecting samples from pre-continent children can be difficult.

Avant Doctor in Training Research Scholarship 2015 recipient, Dr Jonathan Kaufman (pictured), a registrar and Paediatric Advanced Trainee at the Royal Children’s Hospital in Melbourne, aims to use the part-time scholarship to demonstrate the viability of an improved urine collection method. Dubbed ‘Quick-Wee’, it aims to help clinicians collect urine samples quickly, for young children in the emergency department and beyond.

Dr Kaufman, 35, will lead the Quick-Wee Randomised Controlled Trial at the Royal Children’s Hospital and Murdoch Children’s Research Institute in Melbourne, while completing a Doctor of Medical Science degree at the University of Melbourne. The scholarship represents another career highlight for Dr Kaufman who was awarded the Advanced Trainee Research Prize in 2014 at the Royal Children’s Hospital and Victorian Paediatric Trainee Research Award for Excellence from the Royal Australasian College of Physicians in 2015. He has also held leadership roles as a Deputy Chief Resident Medical Officer at the Royal Children’s Hospital and a Paediatric Life Support Instructor for junior doctors.

Interest in paediatrics a natural progression  

Dr Kaufman’s interest in paediatrics has grown over the years after working as an assistant teacher and sports coach at a primary school in Oxford, United Kingdom, during a gap year. “I’ve always enjoyed working with kids as a sports coach, and working in my previous career as a physiotherapist I found I really enjoyed working with children in the hospital setting,” he says.

Limitations with Clean Catch Urine collection method  

Clinicians commonly need to collect urine samples in young children to either diagnose or exclude urinary tract infections, however this can be a difficult and time-consuming process as young children are rarely toilet trained. Dr Kaufman says the idea for the Quick-Wee urine collection method came during a night-shift while working as a Paediatric Registrar at Geelong Hospital in Victoria.   

“I was frustrated by the limitations of our current urine collection methods and I had noticed that when you do the routine cleaning of the perigenital region before you use a catheter or a suprapubic needle aspirate, sometimes that cold stimulation from the cleaning seems to trigger the children to void,” he says. “I wondered if that could be the basis for a more formal technique for collecting non-invasive urine samples.”

Research supervisors play pivotal role  

Dr Kaufman developed his idea into a series of research trials with the help of his supervisors. His primary supervisor and mentor is world-leading researcher in paediatrics, A/Prof Franz Babl, a Paediatric Emergency Physician at the Royal Children’s Hospital and Head of Emergency Research, Murdoch Children’s Research Institute. His secondary supervisor is A/Prof Penelope Bryant, Paediatric Infectious Diseases Physician at the Royal Children’s Hospital and Group Leader, Murdoch Children’s Research Institute Clinical Paediatric Research Group.  

‘Quick-Wee’ collection technique shows promise in pilot study    

The initial baseline study analysing the current Clean Catch Urine collection method in over 200 children at the Royal Children’s Hospital found it was associated with lengthy waiting times for sample collection, as well as high rates of contamination, ‘missed catches’, and collection abandonment. Only 12% of children voided within five minutes.

“The Quick-Wee method is a new technique which uses gentle suprapubic stimulation with wet gauze to trigger cutaneous voiding reflexes in young children,” Dr Kaufman says. The pilot study in 40 children has already showed promising results, indicating a success rate of voiding in 35% of children within five minutes using Quick-Wee.

“We found that it was a feasible urine collection method and importantly that the technique was well-liked by clinicians and families,” he says.   

Randomised controlled trial  

The scholarship will now support a large randomised controlled trial in 354 infants aged under one year recruited from the emergency department to provide high-quality evidence for the Quick-Wee urine collection method. Children will be randomised to receive either standard care or Quick-Wee, to analyse whether the infant voids urine for clean catch collection within five minutes. Secondary outcomes will measure successful catch of urine samples, parental and clinician satisfaction with the technique, sample contamination rates and subsequent clinical management.

New method hopes to inform guidelines

Dr Kaufman anticipates that if this trial confirms that Quick-Wee is a faster and more reliable urine collection method it may ultimately inform Australian and international guidelines for investigation of urinary tract infections in young children in the future.

“We are hoping that the randomised controlled trial will demonstrate that Quick-Wee is a simple and very practical method of urine collection that can be incorporated into any clinician’s day-to-day practice in emergency departments, hospital wards or clinics,” he says. “We think it will help to reduce the need for painful and distressing invasive collection methods, reduce how long patients have to wait for urine sample collection and diagnosis, and improve parent and clinician satisfaction with the urine collection process,” he says.

Avant scholarship opens doors

An Avant member since joining as a medical student, Dr Kaufman says he is humbled and grateful to Avant for the support of the scholarship.

“Particularly for junior doctors who are combining part-time research and clinical training like myself, it’s a unique opportunity because most of the research scholarships available are for full-time research only,” he says. “Scholarships like this allow you to bring your research to a higher standard and really opens the door to future opportunities to collaborate with senior researchers, and then over time develop more independent research and then hopefully a career which combines clinical work and academic research.”

Does your research deserve funding?

Applications for the 2016 Avant Doctor in Training Research Scholarship Program are open. Twenty-two scholarships are available – more than any other year to date – worth $450,000, for both emerging and experienced researchers. 

Apply online on the Avant website or for more information download our Doctor in Training Research Scholarship Information Pack.

If you have any questions, please contact the Doctor in Training Research Scholarship team at scholarship@avant.org.au.Applications close 31 May 2016.