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J Korean Soc Emerg Med > Volume 18(6); 2007 > Article
Journal of The Korean Society of Emergency Medicine 2007;18(6): 584-589.
Usefulness of Clinical Treatment Protocol on the Acute Pyelonephritis for Diabetic and Elderly Female Patients
Hui Jai Lee, Kyu Seok Kim, You Hwan Jo, Jin Wook Kang, Jung Woo Lee, Jung Ho Shin, Joong Eui Rhee, Gil Joon Suh
1Department of Emergency Medicine, College of Medicine, Seoul National University, Seoul, Korea. dremkks@snubh.org
2Department of Emergency Medicine, Korea University, Seoul, Korea.
ABSTRACT
PURPOSE:
To know the feasibility of ED observation unit treatment for acute pyelonephritis (APN) in women with diabetes or older age.
METHODS:
From January 2006 to February 2007, we enrolled adult women APN patients with diabetes or older age (65 years old or more) prospectively, and managed them with predetermined written protocol including intravenous ciprofloxacin, anti-pyretics, anti-emetics, and hydration. After 6 hour observation, we evaluated the patients to be admitted or not according to the protocol (the after group). From May 2003 to December 2005, data of ED visited APN patients were collected retrospectively for comparison (the before group). We compared the admission rates, re-visits to ED, and ultimate admission rates in older or diabetic patients in the before- and after-protocol group.
RESULTS:
55 and 39 diabetic cases were enrolled respectively in the before- and after group respectively. The initial admission rate in diabetic patients was significantly lower in the after group (31.6% vs 76.4% p<0.001) and the revisit rate was not significantly different (p=0.586). In older patients, 95 and 57 cases were enrolled respectively. The initial admission rate was significantly lower in after group (69.5% vs 42.1%) and the revisit rate was not statistically different (p=0.452).
CONCLUSION:
For diabetic and older women patients with APN, ED observation unit treatment protocol can be applied safely and shows significant decrease in admission rate.
Key words: Pyelonephritis, Diabetes Mellitus, Aged, Clinical Protocols
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