scholarly journals The Kern Fever in the Emergency Department Study (Kern FEDS): Clinical appearance, serious bacterial illness, and the meaning of uncertainty.

2014 ◽  
Author(s):  
Paul Walsh ◽  
Allan Capote ◽  
Davinder Garcha ◽  
Vu Nguyen ◽  
Yvette Sanchez ◽  
...  
Keyword(s):  
Emergency Department ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Bacterial Meningitis ◽  
Blood Cultures ◽  
Clinical Appearance ◽  
Physical Findings ◽  
Fever Management ◽  
Management Algorithms

Background: Emergency department (ED) fever management algorithms require the clinician to categorize febrile children as ‘ill’ or ‘not ill’ appearing when determining the risk for serious bacterial illness (SBI). This study describes a natural experiment where an ED pediatric chart allowed clinicians a third option, ‘unsure’. Hypotheses: We hypothesized (1) that chart prompts would improve documentation of clinical appearance, and (2) that exam findings and prevalence of serious bacterial illness in infants categorized as ‘unsure’ would be intermediate between those who were ill and not ill appearing. Design: We conducted a retrospective study of 3005 ED patients aged 0-24 months who had microbiology testing for fever in the ED between 1/1/2006 and 11/30/2009. We modeled overall appearance as the dependent and individual physical findings as the independent variables with ordinal logistic regression to help establish the validity of clinical appearance as a concept. We then compared the prevalence of the components of SBI, bacterial meningitis, pneumonia, urinary tract infection (UTI) and positive blood cultures, between the categorizations, not ill appearing, unsure and ill appearing. Results: Clinical appearance was documented in 60/583 (10.3%) whose encounter was recorded on the template without prompts versus 2036/2420 (84%) with prompts (p<0.001). Age odds ratio (OR) 1.04 (95% CI 1.01, 1.07) weight (quintile) OR 0.81 (95% CI 0.70, 0.95), dehydration OR 9.68 (95% CI 7.17, 13.01), tachycardia OR 1.31 (95% CI 1.04, 1.68), tachypnea OR 2.44 (95% CI 1.61, 3.68), prior antipyretics OR 0.65 (95% CI 0.52, 0.83) and prior antibiotics OR 2.56 (95%CI 1.71, 3.82) were associated with appearance. There was an ordinal relationship between appearance and the prevalence of bacterial meningitis and pneumonia for the categories ill appearing, unsure, and not ill appearing. The prevalence of positive blood cultures among children categorized as ‘not ill appearing' and 'unsure' was similar. Urinary tract infection (UTI) prevalence was similar regardless of appearance. Conclusion: Charting prompts increased documentation of clinical appearance. There was an ordinal relationship between the prevalence of meningitis, and pneumonia, across the categories 'ill appearing', 'unsure' and 'not ill appearing'. This was not the case for blood cultures or UTI.

scholarly journals The Kern Fever in the Emergency Department Study (Kern FEDS): Clinical appearance, serious bacterial illness, and the meaning of uncertainty.

2014 ◽  
Author(s):  
Paul Walsh ◽  
Allan Capote ◽  
Davinder Garcha ◽  
Vu Nguyen ◽  
Yvette Sanchez ◽  
...  
Keyword(s):  
Emergency Department ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Bacterial Meningitis ◽  
Blood Cultures ◽  
Clinical Appearance ◽  
Physical Findings ◽  
Fever Management ◽  
Management Algorithms

Background: Emergency department (ED) fever management algorithms require the clinician to categorize febrile children as ‘ill’ or ‘not ill’ appearing when determining the risk for serious bacterial illness (SBI). This study describes a natural experiment where an ED pediatric chart allowed clinicians a third option, ‘unsure’. Hypotheses: We hypothesized (1) that chart prompts would improve documentation of clinical appearance, and (2) that exam findings and prevalence of serious bacterial illness in infants categorized as ‘unsure’ would be intermediate between those who were ill and not ill appearing. Design: We conducted a retrospective study of 3005 ED patients aged 0-24 months who had microbiology testing for fever in the ED between 1/1/2006 and 11/30/2009. We modeled overall appearance as the dependent and individual physical findings as the independent variables with ordinal logistic regression to help establish the validity of clinical appearance as a concept. We then compared the prevalence of the components of SBI, bacterial meningitis, pneumonia, urinary tract infection (UTI) and positive blood cultures, between the categorizations, not ill appearing, unsure and ill appearing. Results: Clinical appearance was documented in 60/583 (10.3%) whose encounter was recorded on the template without prompts versus 2036/2420 (84%) with prompts (p<0.001). Age odds ratio (OR) 1.04 (95% CI 1.01, 1.07) weight (quintile) OR 0.81 (95% CI 0.70, 0.95), dehydration OR 9.68 (95% CI 7.17, 13.01), tachycardia OR 1.31 (95% CI 1.04, 1.68), tachypnea OR 2.44 (95% CI 1.61, 3.68), prior antipyretics OR 0.65 (95% CI 0.52, 0.83) and prior antibiotics OR 2.56 (95%CI 1.71, 3.82) were associated with appearance. There was an ordinal relationship between appearance and the prevalence of bacterial meningitis and pneumonia for the categories ill appearing, unsure, and not ill appearing. The prevalence of positive blood cultures among children categorized as ‘not ill appearing' and 'unsure' was similar. Urinary tract infection (UTI) prevalence was similar regardless of appearance. Conclusion: Charting prompts increased documentation of clinical appearance. There was an ordinal relationship between the prevalence of meningitis, and pneumonia, across the categories 'ill appearing', 'unsure' and 'not ill appearing'. This was not the case for blood cultures or UTI.

National Trends in Emergency Department Antibiotic Prescribing for Elders with Urinary Tract Infection, 1996-2005

2009 ◽  
Vol 16 (6) ◽  
pp. 500-507 ◽  
Author(s):  
Jeffrey M. Caterino ◽  
Sarah Grace Weed ◽  
Janice A. Espinola ◽  
Carlos A. Camargo, Jr
Keyword(s):  
Emergency Department ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Antibiotic Prescribing ◽  
National Trends

scholarly journals Leveraging Antimicrobial Stewardship in the Emergency Department to Improve the Quality of Urinary Tract Infection Management and Outcomes

2018 ◽  
Vol 5 (6) ◽  
Author(s):  
Sarah C J Jorgensen ◽  
Samantha L Yeung ◽  
Mira Zurayk ◽  
Jill Terry ◽  
Maureen Dunn ◽  
...  
Keyword(s):  
Emergency Department ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Antimicrobial Stewardship ◽  
Treatment Algorithm ◽  
Rapid Change ◽  
Audit And Feedback ◽  
Prescribing Practices ◽  
Return Visits

Abstract Background The complex and fast-paced emergency department (ED) practice setting presents unique challenges that demand a tailored approach to antimicrobial stewardship. In this article, we describe the strategies applied by 1 institution’s antimicrobial stewardship program (ASP) that were successful in improving prescribing practices and outcomes for urinary tract infection (UTI) in the ED. Methods Core strategies included pre-implementation research characterizing the patient population, antimicrobial resistance patterns, prescribing behavior, and morbidity related to infection; collaboration across multiple disciplines; development and implementation of a UTI treatment algorithm; education to increase awareness of the algorithm and the background and rationale supporting it; audit and feedback; and early evaluation of post-implementation outcomes. Results We observed a rapid change in prescribing post-implementation with increased empiric nitrofurantoin use and reduced cephalosporin use (P &lt; .05). Our elevation of nitrofurantoin to firstline status was supported by our post-implementation analysis showing that its use was independently associated with reduced 30-day return visits (adjusted odds ratio, 0.547; 95% confidence interval, 0.312–0.960). Furthermore, despite a shift to a higher risk population and a corresponding decrease in antimicrobial susceptibility rates post-implementation, the preferential use of nitrofurantoin did not result in higher bug-drug mismatches while 30-day return visits to the ED remained stable. Conclusions We demonstrate that an outcomes-based ASP can impart meaningful change to knowledge and attitudes affecting prescribing practices in the ED. The success of our program may be used by other institutions as support for ASP expansion to the ED.

Risk factors for early return visits to the emergency department in patients with urinary tract infection

2018 ◽  
Vol 36 (1) ◽  
pp. 12-17 ◽  
Author(s):  
Sarah Jorgensen ◽  
Mira Zurayk ◽  
Samantha Yeung ◽  
Jill Terry ◽  
Maureen Dunn ◽  
...  
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Early Return ◽  
Return Visits

scholarly journals 876Strategies for Success in Emergency Department Catheter-Associated Urinary Tract Infection Prevention Programs

2014 ◽  
Vol 1 (suppl_1) ◽  
pp. S251-S252
Author(s):  
Eileen J. Carter ◽  
Daniel J. Pallin ◽  
Leslie Mandel ◽  
Corine Sinnette ◽  
Jeremiah Schuur
Keyword(s):  
Emergency Department ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Infection Prevention ◽  
Prevention Programs

scholarly journals Association of dementia diagnosis with urinary tract infection in the emergency department

2020 ◽  
Vol 1 (6) ◽  
pp. 1291-1296
Author(s):  
Lindsey C. Yourman ◽  
Tyler J. Kent ◽  
Juhi S. Israni ◽  
Kelly J. Ko ◽  
Adriane Lesser
Keyword(s):  
Emergency Department ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Dementia Diagnosis

scholarly journals Bladder Diverticulitis: A Case Report

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Michael Silberman ◽  
Rebecca Jeanmonod
Keyword(s):  
Emergency Department ◽  
Urinary Tract Infection ◽  
Abdominal Pain ◽  
Case Report ◽  
Urinary Tract ◽  
Tract Infection ◽  
Acute Urinary Retention ◽  
Disease Process ◽  
Multifactorial Disease ◽  
Bladder Diverticulum

Bladder diverticulum, an outpouching of the mucosa through the muscular wall of the bladder, is a multifactorial disease process that can be either acquired or congenital. Although small diverticuli are usually asymptomatic, a large diverticulum may result in hematuria, urinary tract infection, acute abdomen due to its rupture, acute urinary retention, or neoplasm formation. We describe the case of an elderly gentleman who presented to the emergency department with abdominal pain and was ultimately diagnosed with bladder diverticulitis, a disease not previously described in the literature.

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