Management of acute pyelonephritis in the emergency department observation unit

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.

Analysis on the etiology of seizures in a cohort of 975 children admitted to a pediatric emergency department / 中国小儿急救医学

Objective To document the etiologies of seizures in children admitted to the pediatric observation unit of an inen r city hospital in Chian .Me thods A ot tal of 975 children ( aged 1 month to 18 years old) admitted to the pediatric observation unit of Guangzhou Women adn Children′s Medical Center between October,2013 and October,2014 with seizures were evaluated restrospectively.Results A total of 975 patients were included in this study.The causes of seizures were febrile seizures ( 588 cases,60.3%) , epilepsy( 163 cases, 16.7%) , and benign inaf ntile convulsions associated with mild gasrt oenteritis ( 111 cases,11.4%) .The main causes of seizures for children less than one year old were febrile seizures ( 75 cases,34.1%) and epilepsy(75 cases,34.1%),following by the intracranial infection(22 cases,10.0%). Febrile seizures also predominated the causes of seizures among children between one and six years old(487 cases, 70.3%),whereas benign infantile convulsions associated with mild gastroenteritis accounting for 14.0%(97 cases) of all causes.Meanwhile, the leading causes of seizures for children of six years or older were febrile seizures(26 cases,41.9%) and epilepsy(20 cases,32.3%).Conclusion Febrile seizures is the leading cause of seizures among children.Contrast to previous studies,the proportions of epilepsy and benign infantile convulsions associated with mild gastroenteritis are increasing,while the proportion of intracranial infection is reducing.Rapid assessment and accurately identifying the etiology play an important role in the management of seizures.

Clinical analysis of 5471 cases in a pediatric emergency observation unit / 中国小儿急救医学

Objective To evaluate the role of an emergency observation unit(OU) in pediatric care.Methods A retrospective study was conducted to evaluate the medical service of the OU for 12 months.Results During 12 months,5?471 children were admitted to the OU,which was 0.78% of all visits to the outpatient department(OD) and emergency department(ED).Of OU patients,70.9% children were discharged home and 34.6% children were discharged under 48 hours.Of OU patients,65.6% children were under 2 years old.Median length of stay was 95.7 hours.The average admission rate was 15 children per day.The patient volume per month of OU was in positive relation with the visits volume per month of OD and ED (r=0.835,P=0.001).The commonest causes for children admitted to the observation unit were pneumonia(22.2%),enteritis(13.3%) and acute upper airway infection(11.4%).Conclusion The emergency pediatric OU should be set to assess and treat young children with a variety of conditions.It is effective in relieving the problems of limited inpatient hospital bed spaces and high-volume patient visits,and helpful for limiting inappropriate hospitalization.