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Factors for return to emergency department and hospitalization in elderly urinary tract infection patients

Authors
Myoung, J.Y.Hong, J.Y.Lee, D.H.Lee, C.A.Park, S.H.Kim, D.H.Kim, E.C.Lim, J.Y.Han, S.Choi, Y.H.
Issue Date
Dec-2021
Publisher
W.B. Saunders
Keywords
Antibiotic resistance; Early return visit; Elderly patients; Emergency department; Empirical antibiotic; Urinary tract infection
Citation
American Journal of Emergency Medicine, v.50, pp 283 - 288
Pages
6
Journal Title
American Journal of Emergency Medicine
Volume
50
Start Page
283
End Page
288
URI
https://scholarworks.bwise.kr/cau/handle/2019.sw.cau/49509
DOI
10.1016/j.ajem.2021.08.015
ISSN
0735-6757
1532-8171
Abstract
Background: Appropriate decision of emergency department (ED) disposition is essential for improving the outcome of elderly urinary tract infection (UTI) patients. However, studies on early return visit (ERV) to the ED in elderly UTI patients are limited. Therefore, we aimed to identify factors for ERV and hospitalization after return visit (HRV) in this population. Methods: Elderly patients discharged from the ED with International Classification of diseases 10th Revision codes of UTI were selected from the registry for evaluation of ED revisit in 6 urban teaching hospitals. Retrospective data were extracted from the electronic medical records and ERV and hospitalization to scheduled revisit (SRV) were compared. Result: Among a total of 419 patients found in the study period, 45 were ERV patients and 24 were HRV patients. Absence of UTI-specific symptoms (odds ratio [OR] 2.789; 95% confidence interval [CI] 1.368–5.687; P = 0.005), C-reactive protein (CRP) levels >30 mg/L (OR 2.436; 95% CI 1.017–3.9; P = 0.024), and body temperature ≥ 38 °C (OR 1.992; 95% CI 1.017–3.9; P = 0.044) were independent risk factors for ERV, and absence of UTI-specific symptoms (OR 3.832; 95% CI 1.455–10.088; P = 0.007), CRP levels >30 mg/L (OR 3.224; 95% CI 1.235–8.419; P = 0.017), and systolic blood pressure ≤ 100 mmHg (OR 3.795;95% CI 1.156–12.462; P = 0.028) were independent risk factors for HRV. However, there was no significant difference in empirical antibiotic resistance in ERV and HRV patients, compared to SRV patients. Conclusion: The independent risk factors of ERV and HRV should be considered for ED disposition in elderly UTI patients; the resistance to empirical antibiotics was not found to affect ERV or HRV within 3 days. © 2021
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