<p>Status Quo of Diagnostic Procedures and Treatment of Inpatients with Infective Endocarditis at the Department of General Medicine at a University Hospital in a Suburban City in Japan: A Single-Hospital-Based Retrospective Study</p>

Abstract

Background: Our hospital's department of general medicine is often involved in the diagnosis and treatment of diseases that are considered by other hospitals or other departments in our hospital to be difficult to diagnose correctly. Objective: The aim of this study was to clarify how patients with infective endocarditis (IE) being admitted to our hospital's department of general medicine were examined and treated and to elucidate their prognosis compared with patients admitted to other departments. Materials and Methods: Inpatients of Saga University Hospital with definite IE from September 2007 to August 2017 were divided into 2 groups: those admitted to the general medicine department (the GM group) and those admitted to other departments (the non-GM group). Results: Seventy-four patients were included; 17 (23%) were admitted to the general medicine department. In the GM group, the percentage of patients diagnosed with definite or suspected IE was lower (0% vs 32%, p=0.008), as was the rate of patients with echocardiographic findings that fulfilled the major modified Duke's criteria (71% vs 98%, p≤0.001), preadmission. The GM group had higher percentages of patients with back or joint pain (41% vs 9%, p=0.001) and complications, including pyogenic spondylitis (35% vs 2%, p≤0.001), deep-seated abscesses (24% vs 5%, p=0.024), pyogenic arthritis (18% vs 0%, p=0.001), and glomerulonephritis (77% vs 37%, p=0.004) than did the non-GM group. Mortality within 30 days of admission to our hospital (12% vs 14%, p=0.753) and overall inhospital mortality (12% vs 18%, p=0.570) did not significantly differ. Conclusion: The general medicine department could have accurately diagnosed IE, given appropriate treatments, and obtained similar prognoses to those of IE patients treated by other departments, including cardiology and cardiovascular surgery, even in patients for whom diagnosing IE was more difficult or who had less typical echocardiographic findings preadmission.

How Do We Establish the Utility and Evidence of General Medicine in Japan?

“… 14 The evidence supporting the clinical benefits of GM is currently limited, with most evidence regarding cost reduction and improvement in quality of care derived from small-scale, single-center studies. 15 , 16 These studies cover a range of clinical areas, including improved quality of inpatient care for infectious endocarditis, 17 increased blood culture collection rate, 18 shortened length of hospital stay, 19 improved quality of home medical care, 20 COVID-19 care, 21 compensating for the shortage of specialists, 22 and improved heart failure management. 23 Studies have been conducted on the patient population, locations, and clinical skills covered during GM training.…”