title: Inpatient management of gout in a New Zealand hospital: a retrospective audit.
abstract: OBJECTIVE
  To review inpatient management of acute gout in a New Zealand hospital.
  
  
  METHODS
  A retrospective file review of all acute episodes of gout at Hutt Hospital, Wellington, New Zealand over a 1 year period.
  
  
  RESULTS
  In the course of a year, there were 90 admissions for, or complicated by, acute gout. In 31 cases, gout was the primary diagnosis. Median length of stay was 5 days and readmissions were common. The majority of patients (87%) were known to have gout before admission, yet only 50% of these patients were on uric acid lowering treatment. Serum urate was measured in only 60% of patients with a mean level of 0.471 mmol/L. Treatment for the acute attack was evenly split between monotherapy (49%) and polytherapy (49%). Treatment modalities used were: prednisone (61%), non-steroidal anti-inflammatories (40%), colchicine (40%), adrenocorticotrophic hormone (ACTH) (15%) and intrarticular steroids (7%). Patients were generally treated in a timely manner with few patients experiencing delays. Patients seen by the Rheumatology Department were more likely to receive polytherapy, be treated with intra-articular steroids or ACTH and to start allopurinol. The 'treat-to-target' approach to the management of elevated serum urate was mentioned in only 9% of cases.
  
  
  CONCLUSIONS
  There was considerable variability in the investigation and management of acute gout, with significant deviation from published protocols. The 'treat-to-target' approach to the management of elevated urate has not yet been widely adopted by the physicians in this New Zealand hospital.
authors: Wellington Regional Rheumatology Unit, Hutt Valley DHB, Lower Hutt, New Zealand.
authors: Nicholas J
authors: NJ
authors: Kennedy
authors: Wellington Regional Rheumatology Unit, Hutt Valley DHB, Lower Hutt, New Zealand.
authors: Paul J
authors: PJ
authors: Healy
authors: Wellington Regional Rheumatology Unit, Hutt Valley DHB, Lower Hutt, New Zealand.
authors: Andrew A
authors: AA
authors: Harrison
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D004359:Drug Therapy, Combination; D017723:Drug Utilization Review; D005260:Female; D006073:Gout / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D006074:Gout Suppressants / Q000627:therapeutic use*; D019983:Guideline Adherence; D006801:Humans; D007297:Inpatients; D007902:Length of Stay; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009520:New Zealand; D010359:Patient Readmission; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D015854:Up-Regulation; D014527:Uric Acid / Q000097:blood; D055815:Young Adult
chemical_list: D015415:Biomarkers; D006074:Gout Suppressants; D014527:Uric Acid
keywords: Gout; New Zealand; hospital; management; treat to target