Advanced elderly patients with febrile episode on admission

Fukuda, Yukiko; Sugihara, Eiichiro; Nakajima, Naoya; Aiba, Miyoji; Isonuma, Hiroshi; Hayashida, Yasuo

doi:10.14789/pjmj.53.598

Cited by 3 publications

(2 citation statements)

References 3 publications

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“…9) 10) Among them, infection is reportedly the most frequent, with similar findings noted in the present study. 11) Bacterial infection, such as that at the upper airway, lower airway, or urinary tract, is typically controlled by appropriate antibiotics. 12) 13) Virus infection, such as the common cold, is also controlled by supportive therapy.…”

Section: Discussionmentioning

confidence: 99%

Clinical Significance of C-Reactive Protein in Patients with Trauma on Arrival

Nagasawa

Omori

Takeuchi

et al. 2019

Juntendo Medical Journal

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Objective: To investigate to investigate significance of C-reactive protein (CRP) in patients with trauma on arrival. Materials: From September 2017 to February 2018, a medical chart review was retrospectively performed for all patients with trauma who were admitted to our department. Methods: The subjects were divided into two groups: a CRP-negative group (initial CRP level ≤0.3 mg/dl) and a CRP-positive group (> 0.3 mg/dl). For the CRP-positive group, we additionally investigated the cause of the increased level of CRP. Results: There were 33 cases in the CRP-positive group and 168 in the CRP-negative group. The age and ratio of lymphocytes in the CRP-positive group was significantly higher than those in the CRP-negative group. Twenty-two to twenty-eight of the 33 cases (67-85%) had an infection, 3 of 33 (9%) had a delayed visit (over 24 h from the onset of the trauma) to the emergency department, and 2 cases (6%) had malignancy in the CRP-positive group. All subjects with an increased CRP level on arrival potentially had underlying diseases that might have caused their trauma. Conclusion: Some traumatized patients may have elevated CRP levels on arrival due to underlying diseases capable of causing trauma. An increased initial level of CRP did not significantly affect the clinical outcome; however, physicians should pay attention to the cause of the increased CRP level, which may affect the patientʼs outcome. Exploring increased CRP levels may be useful for identifying the mechanism underlying the occurrence of trauma.

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Section: Discussionmentioning

confidence: 99%

Clinical Significance of C-Reactive Protein in Patients with Trauma on Arrival

Nagasawa

Omori

Takeuchi

et al. 2019

Juntendo Medical Journal

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“…A study conducted by Fukuda et al of our department showed that elderly patients hospitalized for pneumonia have a higher mortality rate if they have a low body temperature at admission 1) . There is a supposition that patients with a high body temperature are likely to have a high risk of mortality, but in fact the mortality rate is higher for those with a low body temperature.…”

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confidence: 88%

Clinical Approach to Febrile Patients

Naito

2016

Juntendo Medical Journal

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Hotline system provides year-round phone consultation service for inquiries from each hospital department. The most common incoming call is, as expected,"We have a patient with a fever!"However, at present there are many physicians who say"We have not done a blood culture,"and"As a stopgap , we started the patient on an antibiotic as of yesterday."In fact, reaching a diagnosis of a nosocomial fever without having performed the first work-up for a fever (i.e., two sets of blood culture, chest X-rays taken in two directions, and general urinalysis and smear culture) is like reaching a diagnosis of myocardial infarction without performing an ECG. The root of these problems is a lack of awareness of the importance of the initial response to febrile patients. Ill-considered administration of an antibiotic can result in delayed (perhaps indefinitely) diagnosis of a patient with infectious endocarditis. In fact, since the causative organism of infectious endocarditis is unknown, in most cases there has been earlier administration of an antibiotic. We carried out a collaborative retrospective clinical study at 17 hospitals affiliated with the Japanese Society of Hospital General Medicine to investigate the diagnostic methods used for causative diseases of fevers of unknown origin (FUO). We found that, even for patients with classical FUO, blood cultures were not performed in 13.2% of the patients with FUO. To exclude bacteremia, it is necessary to perform two sets of blood culture using blood drawn when the patient has not been administered an antibiotic for at least 48 h. When a catheter-related blood infection is suspected, simultaneous culture of the catheter tip and blood should be submitted. In our hospital, the rate of collection of two sets of blood culture and the rate of submission of only catheter culture are reported for each department. The problems with blood inflammatory markers (e.g., WBCs, CRP, ESR, etc.) are that they do not identify the site of inflammation and the assay data do not always match the severity. For inflammation at sites remote from blood, such as meningitis, abscess, etc., the CRP does not always increase. The blood procalcitonin value has been reported to have high specificity for bacterial infections, but evaluations of its clinical usefulness have not shown consistent results. Especially in patients with classical FUO, procalcitonin values were not found to correlate with the causative diseases. Inflammatory markers cannot be relied upon to exclude bacterial infections.

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Clinical analysis of mortality in elderly patients with community-acquired pneumonia

Sakamoto¹,

Sugihara²,

Boku³

et al. 2010

Jpn J Geriat

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We concluded that delay of diagnosis and treatment, dehydration, low levels of protein and albumin were important prognostic factors. The extent of infiltration shadow in chest X-ray findings was also important. A-DROP might be useful for estimating the prognosis in elderly patients with community-acquired pneumonia. We should consider the prognostic factors and severity at the initial stage when treating elderly patients with pneumonia.

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Advanced elderly patients with febrile episode on admission

Cited by 3 publications

References 3 publications

Clinical Significance of C-Reactive Protein in Patients with Trauma on Arrival

Clinical Significance of C-Reactive Protein in Patients with Trauma on Arrival

Clinical Approach to Febrile Patients

Clinical analysis of mortality in elderly patients with community-acquired pneumonia

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