Diagnostic uncertainty and urinary tract infection in the emergency department: a cohort study from a UK hospital.

Shallcross, Laura J, Rockenschaub, Patrick, McNulty, David, Freemantle, Nick, Hayward, Andrew and Gill, Martin J (2020) Diagnostic uncertainty and urinary tract infection in the emergency department: a cohort study from a UK hospital. BMC emergency medicine, 20 (1). p. 40. ISSN 1471-227X. This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs

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Abstract

BACKGROUND

Suspected urinary tract infection (UTI) syndromes are a common reason for empirical antibiotics to be prescribed in the Emergency Department (ED), but differentiating UTI from other conditions with a similar presentation is challenging. We investigated how often an ED diagnosis of UTI is confirmed clinically/microbiologically, and described conditions which present as UTI syndromes.

METHODS

Observational study using electronic health records from patients who attended the ED with suspected UTI and had a urine sample submitted for culture. We compared the ED diagnosis to diagnosis at discharge from hospital (ICD-10 codes), and estimated the proportion of cases with clinical/microbiological evidence of UTI.

RESULTS

Two hundred eighty nine patients had an ED diagnosis of UTI syndrome comprising: lower UTI (191), pyelonephritis (56) and urosepsis (42). In patients admitted to hospital with an ED diagnosis of lower UTI, pyelonephritis or urosepsis, clinical/microbiological evidence of UTI was lacking in 61/103, 33/54 and 31/42 cases respectively. The ED diagnosis was concordant with the main reason for admission in less than 40% of patients with UTI syndromes, and antibiotics were stopped within 72 h in 37/161 patients.

CONCLUSIONS

Clinical/microbiological evidence of UTI was lacking in 60-70% of patients, suggesting scope to revise empirical prescribing decisions for UTI syndromes in light of microbial culture and clinical progression.

Item Type: Article
Additional Information: This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs
Subjects: WD Diseases and disorders of systemic, metabolic or environmental origin > WD400 Emergency medicine
WJ Urogenital system. Urology
Divisions: Clinical Support
Clinical Support > Pathology
Related URLs:
Depositing User: Mrs Yolande Brookes
Date Deposited: 28 May 2020 14:56
Last Modified: 28 May 2020 14:56
URI: http://www.repository.uhblibrary.co.uk/id/eprint/3117

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