Please use this identifier to cite or link to this item: https://doi.org/10.11622/smedj.2020020
Title: Management of acute pyelonephritis in the emergency department observation unit.
Authors: Khoo, Kathleen Swee Min
Lim, Zhen Yu
Chai, Chew Yian 
Mahadevan, Malcolm 
Kuan, Win Sen 
Keywords: emergency service
hospital
observation unit
pyelonephritis
Issue Date: 9-Mar-2020
Publisher: Singapore Medical Journal
Citation: Khoo, Kathleen Swee Min, Lim, Zhen Yu, Chai, Chew Yian, Mahadevan, Malcolm, Kuan, Win Sen (2020-03-09). Management of acute pyelonephritis in the emergency department observation unit.. Singapore Med J. ScholarBank@NUS Repository. https://doi.org/10.11622/smedj.2020020
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.
Source Title: Singapore Med J
URI: https://scholarbank.nus.edu.sg/handle/10635/166508
ISSN: 00375675
DOI: 10.11622/smedj.2020020
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