Soledad Gallardo María, Antón Ane, Pulido Herrero Esther, Itziar Larruscain Miren, Guinea Suárez Rocío, García Gutiérrez Susana, Sandoval Negral Julio César
Servicio de Urgencias, Hospital Galdakao-Usansolo, Bizkaia, España.
Unidad de Investigacion, OSI Barrualde-Galdakao [Osakidetza] - Red de Investigación en Servicios de Salud en Enfermedades Crónicas [REDISSEC], Galdakao, Bizkaia, España.
Emergencias. 2017 Oct;29(5):313-319.
To compare outcomes of urinary tract infections (UTIs) in patients referred to a home hospitalization program or admitted to a conventional ward after initial management in the emergency department.
Prospective, quasi-experimental study of patients with UTIs attended in 3 hospital emergency departments in the public health system of the Basque Country, Spain, between January 2012 and June 2013. Patients were assigned to 2 groups according to site of treatment (home or hospital ward) after discharge from the emergency department. We collected sociodemographic data, history of kidney or urologic symptoms, concomitant diseases, risk for complicated UTI, presentation on admission to the emergency department, diagnostic findings, and prescribed treatments. The main outcome was poor clinical course (local complications during hospital or home care, recurrence, or readmission related to UTI. Multivariate logistic modeling was used to analyze factors related to poor clinical course. Home hospitalization was the main independent variable of interest.
Patients referred to home hospitalization were more often women (70.6% vs 57.1% men, P=.04). Fewer cases of prior admission were recorded in the group treated at home (2.4% vs 9.5% of hospitalized patients, P=.03). Likewise, fewer home-hospitalization patients had risk factors for complicated UTI (58.7% vs 83.3% in the hospitalized group, P<.001). The only significant difference in complications between the 2 groups was a lower rate of acute confusional state in patients assigned to home hospitalization (0.8% vs 8.3% in hospitalized patients, P=.007). The frequency of poor clinical course was similar in home-hospitalized and ward-admitted patients.
The clinical course of UTI is similar whether patients are hospitalized after emergency department management or discharged to a home hospitalization program.
比较在急诊科经过初始治疗后被转诊至家庭住院计划的患者与入住传统病房的患者发生尿路感染（UTI）的结局。
对2012年1月至2013年6月期间在西班牙巴斯克地区公共卫生系统的3家医院急诊科就诊的UTI患者进行前瞻性、准实验性研究。患者在从急诊科出院后根据治疗地点（家中或医院病房）被分为2组。我们收集了社会人口学数据、肾脏或泌尿系统症状史、伴随疾病、复杂性UTI风险、急诊科入院表现、诊断结果和规定治疗。主要结局是临床过程不佳（住院或家庭护理期间的局部并发症、复发或因UTI再次入院）。采用多变量逻辑模型分析与临床过程不佳相关的因素。家庭住院是主要的感兴趣自变量。
被转诊至家庭住院的患者女性更多（70.6%对男性57.1%，P = 0.04）。在家治疗组记录的先前住院病例较少（2.4%对住院患者的9.5%，P = 0.03）。同样，家庭住院患者中具有复杂性UTI风险因素的较少（58.7%对住院组的83.3%，P < 0.001）。两组之间并发症的唯一显著差异是被分配至家庭住院的患者急性意识模糊状态发生率较低（0.8%对住院患者的8.3%，P = 0.007）。家庭住院患者和病房入院患者临床过程不佳的频率相似。
无论是在急诊科治疗后住院还是出院至家庭住院计划，UTI的临床过程相似。
