Diagnosis and Treatment of Acute Gout at a University Hospital Emergency Department.

Q4 Medicine
Open Rheumatology Journal Pub Date : 2015-06-12 eCollection Date: 2015-01-01 DOI:10.2174/18743129014090100021
Naomi Schlesinger, Diane C Radvanski, Tina C Young, Jonathan V McCoy, Robert Eisenstein, Dirk F Moore
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引用次数: 9

Abstract

Background: Acute gout attacks account for a substantial number of visits to the emergency department (ED). Our aim was to evaluate acute gout diagnosis and treatment at a University Hospital ED.

Methods: Our study was a retrospective chart review of consecutive patients with a diagnosis of acute gout seen in the ED 1/01/2004 - 12/31/2010. We documented: demographics, clinical characteristics, medications given, diagnostic tests, consultations and whether patients were hospitalized. Descriptive and summary statistics were performed on all variables.

Results: We found 541 unique ED visit records of patients whose discharge diagnosis was acute gout over a 7 year period. 0.13% of ED visits were due to acute gout. The mean patient age was 54; 79% were men. For 118 (22%) this was their first attack. Attack duration was ≤ 3 days in 75%. Lower extremity joints were most commonly affected. Arthrocentesis was performed in 42 (8%) of acute gout ED visits. During 355 (66%) of ED visits, medications were given in the ED and/or prescribed. An anti-inflammatory drug was given during the ED visit during 239 (44%) visits. Medications given during the ED visit included: NSAIDs: 198 (56%): opiates 190 (54%); colchicine 32 (9%) and prednisone 32 (9%). During 154 (28%) visits an anti-inflammatory drug was prescribed. Thirty two (6%) were given no medications during the ED visit nor did they receive a prescription. Acute gout rarely (5%) led to hospitalizations.

Conclusion: The diagnosis of acute gout in the ED is commonly clinical and not crystal proven. Anti-inflammatory drugs are the mainstay of treatment in acute gout; yet, during more than 50% of ED visits, anti-inflammatory drugs were not given during the visit. Thus, improvement in the diagnosis and treatment of acute gout in the ED may be required.

Abstract Image

Abstract Image

某大学医院急诊科急性痛风的诊断与治疗
背景:急性痛风发作占相当数量的访问到急诊科(ED)。我们的目的是评估急诊科急性痛风的诊断和治疗。方法:我们的研究是对2004年1月1日至2010年12月31日在急诊科诊断为急性痛风的连续患者进行回顾性分析。我们记录了:人口统计学、临床特征、给予的药物、诊断测试、咨询以及患者是否住院。对所有变量进行描述性统计和汇总统计。结果:我们发现541例出院诊断为急性痛风的患者在7年内的独特急诊科就诊记录。0.13%的急诊科就诊是由于急性痛风。患者平均年龄54岁;79%是男性。其中118人(22%)是他们的第一次攻击。75%的攻击持续时间≤3天。下肢关节最常受影响。42例(8%)急性痛风ED患者接受了关节穿刺。在355例(66%)急诊科就诊中,急诊科给药和/或开处方。239例(44%)急诊期间给予消炎药。急诊期间服用的药物包括:非甾体抗炎药:198(56%);阿片类药物:190 (54%);秋水仙碱32(9%)和强的松32(9%)。在154次(28%)就诊中,医生开了消炎药。32人(6%)在急诊科就诊期间没有服用任何药物,也没有收到处方。急性痛风很少(5%)导致住院。结论:急诊科急性痛风的诊断多为临床诊断,缺乏临床证据。抗炎药物是治疗急性痛风的主要药物;然而,在超过50%的急诊科就诊期间,没有给予消炎药。因此,在诊断和治疗急性痛风的ED可能需要改进。
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来源期刊
Open Rheumatology Journal
Open Rheumatology Journal Medicine-Rheumatology
CiteScore
0.80
自引率
0.00%
发文量
2
期刊介绍: ENTHAM Open publishes a number of peer-reviewed, open access journals. These free-to-view online journals cover all major disciplines of science, medicine, technology and social sciences. BENTHAM Open provides researchers a platform to rapidly publish their research in a good-quality peer-reviewed journal. All peer-reviewed accepted submissions meeting high research and ethical standards are published with free access to all.
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