Summary
Outcome in acute uncomplicated pyelonephritis after discharge home following initial hospital emergency department treatment
Affiliation of the authors
DOI
Quote
Lluís M, Miró O, Perea Molera M, Pedrol E, Mijana M, Rodellar MT, et al. Outcome in acute uncomplicated pyelonephritis after discharge home following initial hospital emergency department treatment. Emergencias. 2009;21:325-32
Summary
Objective: To determine the clinical course and safety of patients discharged home after
hospital emergency department treatment of acute uncomplicated pyelonephritis.
Methods: This prospective, longitudinal, noninterventional, multicenter study enrolled
women diagnosed with acute uncomplicated pyelonephritis at 2 hospital emergency
services. No patient stayed in the emergency room longer than 24 hours. Medical
history, current complaints, test results, and prescribed treatment were recorded for all
patients. Between 3 to 5 days after discharge the patient was telephoned to assess
clinical course (resolution of fever, lower back pain, and urinary tract symptoms). If
symptoms persisted, the patient was called again between 7 and 10 days after
discharge. The caller asked if the patient had consulted another doctor and if that
consultation led to changes in treatment and/or hospitalization was required.
Results: Seventy-one patients were enrolled; 83% experienced complete resolution
within 10 days of discharge. The survival curves of cures were practically identical for the
2 emergency services (no significant difference). Lower back pain was the symptom that
took the longest to resolve (P<.01, with respect to both fever and urinary tract symptoms). Twelve patients (16.9%) consulted a doctor again and only 2 (2.8% of the entire cohort) had to be hospitalized. Although certain factors were associated with longer duration of certain symptoms, no particular factor was found to correlate with early resolution. Conclusions: Most patients diagnosed with acute pyelonephritis are cured without requiring hospitalization. Discharge home from the emergency department is therefore justified after an observation period in which a first parenteral antibiotic dose is administered and an appropriate oral antibiotic is chosen. The patient should be warned of the possibility of the persistence of some symptoms and referred for appropriate outpatient follow-up.