TY - JOUR
T1 - The role of emergency ultrasound for evaluating acute pyelonephritis in the ED
AU - Chen, Kuo Chih
AU - Hung, Shih Wen
AU - Seow, Vei Ken
AU - Chong, Chee Fah
AU - Wang, Tzong Luen
AU - Li, Yu Chuan
AU - Chang, Hang
PY - 2011/9
Y1 - 2011/9
N2 - 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.
AB - 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.
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U2 - 10.1016/j.ajem.2010.01.047
DO - 10.1016/j.ajem.2010.01.047
M3 - Article
C2 - 20825875
AN - SCOPUS:80052233761
SN - 0735-6757
VL - 29
SP - 721
EP - 724
JO - American Journal of Emergency Medicine
JF - American Journal of Emergency Medicine
IS - 7
ER -