Clinical features of patients with infective endocarditis presenting to the emergency department

A retrospective case series

Naruhiro Jingushi, Mitsunaga Iwata, Teruhiko Terasawa

Research output: Contribution to journalArticle

Abstract

Infective endocarditis (IE) is an uncommon clinical problem with diverse, nonspecific presentations. Therefore, information on the clinical features of IE patients presenting to emergency departments (EDs) is scarce. To descriptively analyze the pertinent data, we performed a retrospective chart review. We reviewed 15 consecutive IE patients admitted directly from ED in a university hospital in Japan between 2013 and 2015. We compared their clinical features with those of 14 IE patients admitted during the same period without ED presentations. Patients admitted directly from ED were older than those without ED presentations (median, 78 vs. 52 years; adjusted p = 0.036) and were more likely to have come without referrals (referral rate, 21% vs. 86%; adjusted p = 0.012). These patients were less likely to have been treated with antibiotics before admission (antibiotic-exposure rate, 7% vs. 64%; adjusted p = 0.013) and had earlier blood-culture positivity (median, 2 vs. 5 days; adjusted p = 0.012), resulting in earlier diagnosis (median duration of symptoms before diagnosis, 5 vs. 30 days; adjusted p = 0.012). Other clinical features, including causative pathogens and IE-related comorbidities, were similar between the groups, consistent with previous a nationwide Japanese study. In conclusion, most IE patients admitted to the hospital from ED were elderly, were antibiotic-naïve, and had presented without a referral. Relatively few patients had classical presentations of IE. Given the limited data, more research is needed to confirm that IE patients presenting to EDs constitute a unique group of elderly patients with specific clinical features.

Original languageEnglish
Pages (from-to)467-476
Number of pages10
JournalNagoya Journal of Medical Science
Volume79
Issue number4
DOIs
Publication statusPublished - 01-11-2017

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Endocarditis
Hospital Emergency Service
Referral and Consultation
Anti-Bacterial Agents
Hospital Departments
Comorbidity
Early Diagnosis
Japan
Research

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

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title = "Clinical features of patients with infective endocarditis presenting to the emergency department: A retrospective case series",
abstract = "Infective endocarditis (IE) is an uncommon clinical problem with diverse, nonspecific presentations. Therefore, information on the clinical features of IE patients presenting to emergency departments (EDs) is scarce. To descriptively analyze the pertinent data, we performed a retrospective chart review. We reviewed 15 consecutive IE patients admitted directly from ED in a university hospital in Japan between 2013 and 2015. We compared their clinical features with those of 14 IE patients admitted during the same period without ED presentations. Patients admitted directly from ED were older than those without ED presentations (median, 78 vs. 52 years; adjusted p = 0.036) and were more likely to have come without referrals (referral rate, 21{\%} vs. 86{\%}; adjusted p = 0.012). These patients were less likely to have been treated with antibiotics before admission (antibiotic-exposure rate, 7{\%} vs. 64{\%}; adjusted p = 0.013) and had earlier blood-culture positivity (median, 2 vs. 5 days; adjusted p = 0.012), resulting in earlier diagnosis (median duration of symptoms before diagnosis, 5 vs. 30 days; adjusted p = 0.012). Other clinical features, including causative pathogens and IE-related comorbidities, were similar between the groups, consistent with previous a nationwide Japanese study. In conclusion, most IE patients admitted to the hospital from ED were elderly, were antibiotic-na{\"i}ve, and had presented without a referral. Relatively few patients had classical presentations of IE. Given the limited data, more research is needed to confirm that IE patients presenting to EDs constitute a unique group of elderly patients with specific clinical features.",
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Clinical features of patients with infective endocarditis presenting to the emergency department : A retrospective case series. / Jingushi, Naruhiro; Iwata, Mitsunaga; Terasawa, Teruhiko.

In: Nagoya Journal of Medical Science, Vol. 79, No. 4, 01.11.2017, p. 467-476.

Research output: Contribution to journalArticle

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