A Retrospective Study of Geriatric Patients Presenting with Fever to an Accident and Emergency Department in Hong Kong

Abstract

To study the characteristics and outcome of geriatric patients presenting with fever to an emergency department in Hong Kong and to analyse the factors affecting their length of stay. Methods: Retrospective study. Patients aged ≥65 who complained of fever, or with temperature ≥37.5 o C (aural) presenting to the Accident and Emergency Department (AED) of Caritas Medical Centre in Hong Kong from 14 November 2006 to 13 December 2006 were enrolled. The demographic data, clinical information and outcomes were studied. The characteristics of short stay and long stay patients were compared. Results: There were 370 patients in the study. Their median age was 80. Of these patients, 64.9% were category 3 or above, i.e. urgent, emergent or critical. The most common chief complaints were fever, shortness of breath, dizziness and cough. The admission rate was 81.9%. The median length of stay in hospital was 4.3 days. The most common hospital discharge diagnoses were chest infection, urinary tract infection, and fever with unknown cause. The discharge rate within 48 hours was 24.6%. With further analysis, temperature, walking ability, triage category and neutrophil count were significantly different between short stay (≤48 h) and long stay (>48 h) patients. For those discharged alive either from the AED or ward, 20.1% re-attended the AED within 14 days of discharge, and 17.5% of those previously discharged were admitted again for fever or other problems. Conclusion: Elders with fever are a major challenge to the AED and health care facilities. The admission rate for this group of patients is usually high. Elders with poor walking ability, high triage category, high temperature and neutrophil count were prone to have longer stay. (Hong Kong j.emerg.

Aortic Dissection Presented as Paraparesis: A Case Report with Literature Review

“…Incidence of aortic dissection in a local study in Hong Kong was 2.1 per 100,000. 2 The sensitivity of diagnosing aortic dissection was only 54% in A&E department, and the mortality rate was higher in those with delayed diagnosis. 2 Aortic dissection presented with paraplegia is rare.…”

“…2 The sensitivity of diagnosing aortic dissection was only 54% in A&E department, and the mortality rate was higher in those with delayed diagnosis. 2 Aortic dissection presented with paraplegia is rare. DeBakey et al reported that only 2% of patient with aortic dissection presented as paraplegia.…”

Laboratory Tests, Bacterial Resistance, and Treatment Options in Adult Patients Hospitalized with a Suspected Urinary Tract Infection

“…The knowledge that BRIAT does not reduce in-hospital survival or treatment success among stable, non-ICU patients may allow holding back antibiotic therapy in these patients until culture results are available [ 92 ]. This might reduce significantly antibiotic usage, since over >80% of elderly patients presenting to the emergency department with fever are hospitalized [ 99 , 100 , 101 ], and most are treated empirically with antibiotics. Around 40% were reported to have negative urine culture in 1 study [ 8 ].…”