Document Detail


The role of emergency ultrasound for evaluating acute pyelonephritis in the ED.
MedLine Citation:
PMID:  20825875     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND: Controversy remains over the imaging method of choice for evaluating acute pyelonephritis (APN) in the emergency department (ED).
OBJECTIVE: The aim of the study was to determine the efficacy of ultrasound in the diagnosis and management of patients presented to the ED with APN.
METHODS: This was a retrospective study of prospectively collected data. A cohort of ED patients diagnosed as APN were prospectively registered, and their medical records were then retrospectively reviewed for the presence of complications (admitted >14 days, admission to intensive care unit, or received invasive procedures), significant abnormalities (hydronephrosis, polycystic kidney diseases, renal abscess, emphysematous pyelonephritis), and mild abnormalities (cysts, stones, swelling).
RESULTS: The study included 243 patients. Most of the patients received one or more renal imaging studies (n = 206) and 39.5% of which were considered abnormal. The rates of significant abnormalities on different imaging methods were Kidney-ureter-bladder (KUB), 16.3%; emergency ultrasound (EUS), 39.6%; combination of KUB and EUS, 56.6%; and computed tomography, 58.8%. Factors contributed to complicated APN were elderly, male, a history of preexisting renal diseases, current use of catheters, previous renal calculi, and diabetes mellitus. Significant abnormalities can be identified by EUS in 61% of patients with complicated APN. In fact, the presence of significant sonographic abnormalities effectively diverted 34.3% of patients to receive surgical interventions (percutaneous nephrostomy, abscess aspiration, ureteroscopic stone manipulation, lithotripsy, or nephrectomy).
CONCLUSION: Structural abnormalities are not uncommon in ED patients with APN. Early assessment of these patients with EUS is likely to have a great impact on their diagnosis and management.
Authors:
Kuo-Chih Chen; Shih-Wen Hung; Vei-Ken Seow; Chee-Fah Chong; Tzong-Luen Wang; Yu-Chuan Li; Hang Chang
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Publication Detail:
Type:  Journal Article     Date:  2010-05-01
Journal Detail:
Title:  The American journal of emergency medicine     Volume:  29     ISSN:  1532-8171     ISO Abbreviation:  Am J Emerg Med     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-08-29     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8309942     Medline TA:  Am J Emerg Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  721-4     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Elsevier Inc. All rights reserved.
Affiliation:
Emergency Department, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 11101, Taiwan, ROC.
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