Benefits of bladder point-of-care ultrasound for acute ischemic stroke and application of AGN3 criteria.

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.