Early predictors for the diagnosis of liver abscess in the emergency department

Abstract

© 2019, Società Italiana di Medicina Interna (SIMI). Diagnosing pyogenic liver abscess (PLA) in the emergency department (ED) is challenging due to its non-specific clinical presentation. We aim to identify predictors that aid in diagnosis of PLA in ED patients. This retrospective chart review included patients diagnosed with PLA in a tertiary hospital between January 2008 and December 2012. We compared the demographics, clinical characteristics, investigations and outcomes between patients with PLA diagnosed and missed in the ED. During the study period, 155 patients were admitted via the ED with a cause of death or discharge diagnosis of PLA. Mean age was 58.1 (standard deviation [SD] 15.8) years, with male predominance of 69.7%. There were 79.4% of patients with diagnosis of PLA missed in the ED. Fulfillment of SIRS criteria was associated with increased odds of diagnosing PLA in the ED (adjusted OR 3.20, 95% CI 1.03–9.92), while a higher SpO 2 /FiO 2 ratio was associated with decreased odds of a timely ED diagnosis (adjusted OR 0.993, 95% CI 0.988–0.998). Missed ED diagnosis of PLA did not result in significant differences in mortality or treatment failure (p = 0.939), and median length of stay (11 days [IQR 8–16] vs. 11 days [IQR 7–17], p = 0.48). Non-fulfillment of the SIRS criteria and a higher SpO 2 /FiO 2 ratio at ED presentation were associated with higher likelihood of missed diagnosis. Despite that, a missed diagnosis of PLA in the ED did not appear to affect outcomes.