- 作者：Angela M. Arlen ; MD&lowast ; ; Laura S. Merriman ; MD&lowast ; ; Traci Leong ; PhD&dagger ; ; Jared M. Kirsch ; BA&lowast ; ; Edwin A. Smith ; MD&lowast ; ; Bruce H. Broecker ; MD&lowast ; ; Andrew J. Kirsch ; MD&lowast ; ;
- 关键词：pyelonephritis ; hospital admission ; guidelines ; demographics ; Medicaid
- 刊名：Journal of Emergency Medicine
- 出版年：2015
- 出版时间：December 2015
- 年：2015
- 卷：49
- 期：6
- 页码：843-848
- 全文大小：138 K
Objective
We ascertained imaging and characteristics of children presenting to the Emergency Department (ED) with initial fUTI to determine the impact of patient demographics on admissions for pyelonephritis.
Methods
Children aged 2–24 months presenting to the ED with initial fUTI were identified. Demographics, insurance status, laboratory studies, renal-bladder ultrasound (RBUS), VCUG, and hospital admission status were evaluated.
Results
Three-hundred fifty patients met inclusion criteria; 88 (25.1%) were admitted. Admitted patients were significantly (p < 0.001) younger (mean 0.31 ± 0.33 years) than those managed as outpatients (mean 0.91 ± 0.7 years). On univariate analysis, male gender (p < 0.001), Medicaid insurance (p < 0.05), and non-Hispanic race (p < 0.05) were associated with admission. Race retained significance on multivariate analysis; Caucasian children were 2.35 times (95% confidence interval [CI] 0.79–7.23) and African-American children 3.8 times more likely to be admitted than Hispanic patients (95% CI 1.88–7.63). Children with abnormal RBUS were 12.8 times more likely to require admission (95% CI 4.44–37.0). Medicaid was also independently predictive of admission; such patients were 2.6 times more likely to be admitted than those with private insurance (95% CI 1.15–5.88).
Conclusions
Abnormal ultrasound, non-Hispanic race, and public insurance were strongly associated with hospital admission in children presenting to the ED with initial febrile urinary tract infection.