title: A prospective study of acute inpatient gout diagnoses and management in a tertiary hospital: the determinants and outcome of a rheumatology consultation.
abstract: BACKGROUND
  Despite acute gout frequently complicating hospital admissions, diagnosis and management are variable. Rheumatology input may improve patient outcomes.
  
  
  OBJECTIVE
  To examine acute episodes of inpatient gout in a tertiary hospital to determine (i) factors that may lead to rheumatology input being sought and (ii) the differences in outcomes when rheumatology input occurs.
  
  
  METHODS
  Data collection occurred between February and October 2012 for inpatients in a tertiary Australian hospital. Data were prospectively collected for all rheumatology consultations with a diagnosis of gout. Subjects who had an inpatient admission complicated by acute gout and who did not have rheumatology input were identified through health information coding from discharge summaries.
  
  
  RESULTS
  Fifty-eight patients (41% with rheumatology input) were included in the study. Rheumatology input was significantly more likely when the patient was younger (68.9 years vs 78.4 years; P = 0.04) with knee joint involvement (41.7% vs 3.0%; P < 0.001). When rheumatology input occurred, subjects were more likely to have had a serum urate measured (83% vs 50%; P = 0.009), joint aspiration performed (54.2% vs 0%; P < 0.001), been prescribed acute gout medications at discharge (95.8% vs 61.3%; P = 0.001), a documented discharge plan (91.7% vs 23.5%; P < 0.001) and outpatient follow up (41.7% vs 0%; P < 0.001).
  
  
  CONCLUSIONS
  Among inpatients with acute gout, rheumatology input was more likely to be sought in younger patients with knee joint disease. When rheumatology input occurred, patients were more likely to have a synovial fluid confirmed diagnosis of gout with appropriate acute management and a follow-up plan.
authors: Department of Rheumatology, St Vincent's Hospital, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Victoria, Australia; Cardiometabolic Risk Unit, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.
authors: A J
authors: AJ
authors: Teichtahl
authors: L
authors: L
authors: Clemens
authors: M
authors: M
authors: Nikpour
authors: E
authors: E
authors: Romas
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D019468:Disease Management; D005260:Female; D006073:Gout / Q000175:diagnosis* / Q000628:therapy*; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012017:Referral and Consultation; D012219:Rheumatology / Q000379:methods*; D062606:Tertiary Care Centers; D016896:Treatment Outcome
keywords: acute; gout; hospital; rheumatology