OBJECTIVES: To assess process-of-care indicators and outcomes in acute pyelonephritis (APN) in a general hospital emergency department, and compare them between uncomplicaed and complicated APN. MATERIAL AND METHODS: Retrospective study of consecutive patients discharged with a diagnosis of APN. We studied health processof- care indicators (percentage admitted, avoidable hospitalization, appropriate initial antibiotic therapy, urine and blood cultures) and outcomes (hospital length of stay [LOS], discharge from the emergency department, revisits, mortality, yields of microbiological tests ordered). RESULTS: A total of 529 cases (59% of them complicated) were included. Patients with uncomplicated APN were significantly younger on average (mean, 39 years) than patients with complicated APN (56 years). Escherichia coli was the most common pathogen identified, although the percentage of E coli infection was lower in patients with complicated APN (78%) than in patients with uncomplicated APN (95%). The rates of admission and orders for urine and blood cultures were significantly higher and hospital LOS was longer in the group with complicated APN. Moreover, these patients had even longer stays if the initial antibiotic therapy was inappropriate. Significantly more patients with uncomplicated APN were discharged from the emergency department. Sixty-one percent of patients with uncomplicated APN were admitted; 9% of these cases were considered avoidable hospitalizations. CONCLUSION: Complicated APN is diagnosed more often in older patients, and E coli infection causes a smaller proportion of these cases. Hospital LOS is longer in complicated APN and more urine and blood cultures are ordered. Patients with uncomplicated APN are more often discharged from the emergency department, although the number of avoidable hospitalizations seems high based on the rate found in this study.
OBJECTIVES: To assess process-of-care indicators and outcomes in acute pyelonephritis (APN) in a general hospital emergency department, and compare them between uncomplicaed and complicated APN. MATERIAL AND METHODS: Retrospective study of consecutive patients discharged with a diagnosis of APN. We studied health processof- care indicators (percentage admitted, avoidable hospitalization, appropriate initial antibiotic therapy, urine and blood cultures) and outcomes (hospital length of stay [LOS], discharge from the emergency department, revisits, mortality, yields of microbiological tests ordered). RESULTS: A total of 529 cases (59% of them complicated) were included. Patients with uncomplicated APN were significantly younger on average (mean, 39 years) than patients with complicated APN (56 years). Escherichia coli was the most common pathogen identified, although the percentage of E coli infection was lower in patients with complicated APN (78%) than in patients with uncomplicated APN (95%). The rates of admission and orders for urine and blood cultures were significantly higher and hospital LOS was longer in the group with complicated APN. Moreover, these patients had even longer stays if the initial antibiotic therapy was inappropriate. Significantly more patients with uncomplicated APN were discharged from the emergency department. Sixty-one percent of patients with uncomplicated APN were admitted; 9% of these cases were considered avoidable hospitalizations. CONCLUSION: Complicated APN is diagnosed more often in older patients, and E coli infection causes a smaller proportion of these cases. Hospital LOS is longer in complicated APN and more urine and blood cultures are ordered. Patients with uncomplicated APN are more often discharged from the emergency department, although the number of avoidable hospitalizations seems high based on the rate found in this study.
Entities:
Keywords:
Acute complicated pyelonephritis; Acute uncomplicated pyelonephritis; Emergency health services; Hospitalización evitable; Indicadores de proceso; Indicadores de resultado; Pielonefritis aguda complicada; Pielonefritis aguda no complicada; Preventable hospitalization Outcome indicators; Process indicators; Servicio de urgencias
Authors: Young Rock Jang; Su Joa Ahn; Seung Joon Choi; Joong Sik Eom; Yong Kyun Cho; Young Sup Shim; So Hyun Park; Jeong Ho Kim; Hyung-Sik Kim Journal: Abdom Radiol (NY) Date: 2020-08-28
Authors: F J Candel; M Borges Sá; S Belda; G Bou; J L Del Pozo; O Estrada; R Ferrer; J González Del Castillo; A Julián-Jiménez; I Martín-Loeches; E Maseda; M Matesanz; P Ramírez; J T Ramos; J Rello; B Suberviola; A Suárez de la Rica; P Vidal Journal: Rev Esp Quimioter Date: 2018-06-25 Impact factor: 1.553