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A secondary analysis of atypical presentations of older patients with infection in the emergency department of a tertiary care hospital in Thailand

Panita Limpawattana
Panita Limpawattana
, 
Thapanawong Mitsungnern
Thapanawong Mitsungnern
, 
Pariwat Phungoen
Pariwat Phungoen
, 
Natthida Tansangworn
Natthida Tansangworn
 oraz 
Wannisa Laosuangkoon
Wannisa Laosuangkoon
   | 31 sty 2017
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Article Category: Brief communication (Original)
Data publikacji: 31 sty 2017
Zakres stron: 181 - 187
DOI: https://doi.org/10.5372/1905-7415.1002.480
Słowa kluczowe
© 2016 Panita Limpawattana, Thapanawong Mitsungnern, Pariwat Phungoen, Natthida Tansangworn, Wannisa Laosuangkoon
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

Common atypical presentations of common infectious diseases (%) in the ED. Common infectious diseases included acute pneumonia or bronchitis, infective diarrhea, complicated urinary tract infection, skin infection, and septic shock. T<37.8, body temperature <37.8°C, T<37.2 body temperature < 37.2°C, UI urinary incontinence
Common atypical presentations of common infectious diseases (%) in the ED. Common infectious diseases included acute pneumonia or bronchitis, infective diarrhea, complicated urinary tract infection, skin infection, and septic shock. T<37.8, body temperature <37.8°C, T<37.2 body temperature < 37.2°C, UI urinary incontinence

Demographic data and univariate analysis of atypical and typical presentations of older adults with infectious diseases at the emergency department

FactorsTypical (n = 64)(n = 119)Unadjusted OR (95%CI)P
Age (median, IQR 1, 3)75 (71, 80)73 (68, 78)1.05 (1.0, 1.09)0.04

P < 0.05, IQR interquartile range, UTI urinary tract infection, Septic shock: suspected or microbiologically proven infection together with systemic inflammatory response syndrome (SIRS) and hypotension [22]. All patients with septic shock from any cause, such as patients with pneumonia and shock, were counted as part of the septic shock group. There were 59 patients in the atypical group with their number of medications available as data, and 119 in the typical group. There were 115 patients in the typical group with available temperature measurements, 117 with pulse rate, respiratory rate, and systolic blood pressure, and 116 with diastolic blood pressure measurements.

Male (%)31 (47)35 (53)1.06 (0.58, 1.94)0.86
Top 5 diagnoses (%)
 Acute pneumonia/ bronchitis20 (36)35 (64)1.11 (0.57, 2.13)0.76
 Infective diarrhea5 (13)35 (88)0.2 (0.08, 0.55)0.002*
 Complicated UTI20 (69)9 (31)5.56 (2.36, 13.1)<0.001*
 Skin infection3 (83)15 (17)0.1 (0.06, 0.17)<0.001*
 Septic shock7 (47)8 (53)1.72 (0.6, 5)0.32
Comorbid (%)
 Hypertension35 (37)59 (63)1.23 (0.67, 2.26)0.51
 Diabetes mellitus14 (28)37 (73)0.62 (0.31, 1.26)0.19
 Musculoskeletal diseases11 (33)22 (67)0.92 (0.41, 2.03))0.83
 Dyslipidemia14 (47)16 (53)1.8 (0.82, 3.98)0.15
 Chronic kidney disease10 (35)19 (66)0.97 (0.42, 2.24)0.95
 Cancer15 (54)13 (46)2.5 (1.1, 5.64)0.03*
 Cerebrovascular accident8 (69)18 (31)0.8 (0.33, 1.96)0.63
 Coronary artery disease5 (56)4 (44)2.43 (0.63, 9.41)0.2
 Dementia7 (70)3 (30)4.75 (1.18, 19.05)0.03*
 Cirrhosis1 (50)1 (50)1.87 (0.12, 30.45)0.6
Multimorbidity (%)42 (38)69 (63)1.38 (0.74, 2.6)0.31
 Number of medications (median, IQR 1, 3)4 (0, 6)4 (0, 7)1 (0.92, 1.1)0.93
 Vital signs
 Body temperature ( C)37.7 (37, 38.5)37.4 (36.8, 38.2)1.3 (0.97, 1.73)0.08
 Pulse rate >90 beats/min36 (45)44 (55)2.13 (1.15, 3.96)0.02

P < 0.05, IQR interquartile range, UTI urinary tract infection, Septic shock: suspected or microbiologically proven infection together with systemic inflammatory response syndrome (SIRS) and hypotension [22]. All patients with septic shock from any cause, such as patients with pneumonia and shock, were counted as part of the septic shock group. There were 59 patients in the atypical group with their number of medications available as data, and 119 in the typical group. There were 115 patients in the typical group with available temperature measurements, 117 with pulse rate, respiratory rate, and systolic blood pressure, and 116 with diastolic blood pressure measurements.

 Respiratory rate (breaths/min)20 (20, 24)20 (20, 24)1.01 (0.96, 1.06)0.75
 Systolic blood pressure (mmHg)132 (109.5, 146)133 (118, 152)0.99 (0.98, 1.01)0.43
 Diastolic blood pressure (mmHg)75.5 (68, 84)73 (66, 81)1.02 (0.99, 1.04)0.14

Multivariate regression model of factors associated with atypical presentations

FactorsUnadjusted OR

As seen in Table 1.

95% CI

As seen in Table 1.

Adjusted OR95%CIP
Age1.05(1.0, 1.09)1.01(0.96, 1.07)0.57
Diagnosis
 Complicated UTI5.56(2.36, 13.1)4.54(1.75, 11.78)0.002*
 Infective diarrhea0.2(0.08, 0.55)0.27(0.09, 0.8)0.02

P < 0.05, UTI urinary tract infection.

 Skin infection0.1(0.06, 0.17)0.42(0.11, 1.64)0.21
Comorbidity
 Cancer2.5(1.1, 5.64)2.64(1.07, 6.53)0.04

P < 0.05, UTI urinary tract infection.

 Dementia4.75(1.18, 19.05)6.66(1.47, 30.11)0.01

P < 0.05, UTI urinary tract infection.

Vital sign
 Pulse rate >90 beats/min2.13(1.15, 3.96)2.06(1.01, 4.22)0.04

P < 0.05, UTI urinary tract infection.

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Język:
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Częstotliwość wydawania:
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Dziedziny czasopisma:
Medicine, Assistive Professions, Nursing, Basic Medical Science, other, Clinical Medicine
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