Management of acute pyelonephritis in an emergency department observation unit.
OBJECTIVE
To determine whether moderately to severely ill patients with acute pyelonephritis can be treated successfully on an outpatient basis, and whether any aspect of history, physical examination, or initial laboratory data predicts failure of outpatient therapy and the need for hospitalization.


METHODS
Retrospective chart review of all patients with a diagnosis of acute pyelonephritis seen during a three-year period.


METHODS
Emergency department observation unit of an urban teaching hospital serving residents of the city and county of Denver.


METHODS
Women between the ages of 15 and 50 with symptoms, physical examination, and initial laboratory data consistent with a diagnosis of pyelonephritis.


METHODS
Patients received IV antibiotics, rehydration, analgesics, and antiemetics in an observation unit for up to 12 hours, when they were either admitted to the hospital or discharged home on oral antibiotics.


RESULTS
Sixty-three of 87 patients (72%) with acute pyelonephritis were managed successfully as outpatients, nine (22%) were hospitalized directly from the observation unit because they were considered to be too ill to go home, and five (6%) returned with persistent symptoms after ED therapy and were hospitalized. No clinical or laboratory variable predicted success or failure of ED observation unit therapy at the time of initial presentation.


CONCLUSIONS
In selected patients, the observation unit may be used to initiate therapy for acute pyelonephritis. Those with an adequate clinical response to initial treatment may be discharged on oral antibiotic therapy with appropriate follow-up.
Israel
R S
RS
Department of Emergency Medicine, Wilford Hall USAF Medical Center, San Antonio, Texas 78236.
Lowenstein
S R
SR
Marx
J A
JA
Koziol-McLain
J
J
Svoboda
L
L
Ranniger
S
S
D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000592:standards*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003120:Colorado; D003663:Decision Trees; D004636:Emergency Service, Hospital; D005069:Evaluation Studies as Topic; D005260:Female; D005440:Fluid Therapy; D006784:Hospitals, Teaching; D006786:Hospitals, Urban; D006801:Humans; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011704:Pyelonephritis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents