Predictors of admission in patients presenting to the emergency department with urinary tract infection.
OBJECTIVE
Previous studies examining the management of urinary tract infections (UTI) showed marked variability in the economical burden of care, with a tenfold increase in costs when patients require admission to the hospital. We sought to examine the patient and emergency department (ED) characteristics associated with hospitalization in patients presenting to the ED with UTI.


METHODS
An estimate of 10,798,343 patients with a primary diagnosis of UTI was presented to the ED from 2006 to 2009 and was abstracted from the Nationwide Emergency Department Sample. Univariable and multivariable analyses examined patient and hospital characteristics of those admitted with UTI.


RESULTS
Between 2006 and 2009, 10.8 million patients presented to the ED in the United States for the treatment of UTI and 1.8 million patients (16.7 %) were admitted to the hospital for further management. Admitted patients were older, and a higher proportion had pyelonephritis, was male, and had Medicare. Admitted patients were also more likely to be seen at urban teaching hospitals, and/or treated at zip codes with higher median incomes. Following multivariable analysis, the independent predictors of admission included pyelonephritis (OR 5.29, 95 % CI 5.23-5.35), male gender (OR 1.58, 95 % CI 1.56-1.59), and advancing age (OR 1.037, 95 % CI 1.037-1.037).


CONCLUSIONS
Expansion in ED utilization for the management of UTI has exceeded previous estimates. While the preponderance of patients presenting to the ED for UTI is discharged home, 16.7 % are admitted for further management. Predictors of inpatient admission on multivariable analyses included pyelonephritis, advancing age, and male gender.
Vattikuti Urology Institute, Henry Ford Health System, 2799 W. Grand Boulevard, Detroit, MI, 48202, USA, jsammon79@gmail.com.
Jesse D
JD
Sammon
Pranav
P
Sharma
Haider
H
Rahbar
Florian
F
Roghmann
Khurshid R
KR
Ghani
Shyam
S
Sukumar
Pierre I
PI
Karakiewicz
James O
JO
Peabody
Jack S
JS
Elder
Mani
M
Menon
Maxine
M
Sun
Quoc-Dien
QD
Trinh
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000639:trends*; D011379:Prognosis; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000628:therapy*; D055815:Young Adult