Management of acute pyelonephritis in the emergency department observation unit.
- Author:
Kathleen Swee Min KHOO
1
;
Zhen Yu LIM
2
;
Chew Yian CHAI
3
;
Malcolm MAHADEVAN
3
;
Win Sen KUAN
3
Author Information
- Publication Type:Journal Article
- Keywords: emergency service; hospital; observation unit; pyelonephritis
- From:Singapore medical journal 2021;62(6):287-295
- CountrySingapore
- Language:English
-
Abstract:
INTRODUCTION:This study aimed to assess the effectiveness of the emergency department observation unit (EDOU) for patients with acute pyelonephritis in a Singapore tertiary academic medical centre.
METHODS:We reviewed the clinical records of consecutive patients who presented with pyelonephritis between 1 July 2012 and 31 October 2014 to collect information on demographics, symptoms, signs, laboratory and radiological results, treatment, and clinical outcomes.
RESULTS:Of 459 emergency department (ED) patients who were identified as having pyelonephritis, 164 (35.7%) were managed in the EDOU. Successful management in the EDOU was achieved in 100 (61.0%) patients. Escherichia coli was the predominant (64.6%) micro-organism in urine cultures and was positive in 106 patients. Patients diagnosed with acute pyelonephritis who were successfully managed in the EDOU had a lower incidence of nausea (32.0% vs. 60.9%, p < 0.001) and vomiting (15.0% vs. 50.0%, p < 0.001) compared to those who were not successful.
CONCLUSION:EDOU is useful for both observation and treatment of patients with acute pyelonephritis. Urine cultures are sufficient for the identification of the culprit micro-organism. Patients who present with prominent symptoms of vomiting should have routine administration of antiemetics, while consideration for second-line antiemetics is recommended for those with persistent symptoms.
