Academic journal article Australian Health Review

Acute Upper Respiratory Infections in Western Australian Emergency Departments, 2000-2003

Academic journal article Australian Health Review

Acute Upper Respiratory Infections in Western Australian Emergency Departments, 2000-2003

Article excerpt

Abstract

Objective: To describe the epidemiological and other characteristics of emergency department (ED) presentations diagnosed with acute upper respiratory infection (URI).

Design and setting: A retrospective study of patients given an ED diagnosis of acute URI from July 2000 to July 2003 at any of the four metropolitan teaching hospitals in Perth, Western Australia.

Results: Acute URI accounted for 3.6% (95% CI, 3.5-3.7) of ED presentations, and 80.7% (95% CI, 80.1-81.3) of these were aged less than 15 years. The most common diagnosis was acute upper respiratory infections of multiple and unspecified sites, followed by croup and acute tonsillitis. Of those with croup, 76.0% (95% CI, 74.7-77.3) presented at night, 67.6% (95% CI, 66.2-69.0) were male and the number of presentations with croup was highest in June 2002. The number of diagnoses of acute tonsillitis did not display a great deal of variation from month to month. Overall, hospital admission was 12.3% (95% CI, 11.8-12.8), with a median length of hospital stay of 1 day (IQR 1.0-2.0). An increase in comorbidity, residing in the most disadvantaged areas, and being a re-presentation increased the odds of being admitted.

Conclusion: Further investigation is needed into whether alternative medical care services would be appropriate and acceptable for patients with less severe acute URIs.

Aust Health Rev 2008: 32(4): 691-499

UPPER RESPIRATORY INFECTION (URI) is the second most frequent problem managed in Australian general practice, accounting for around 5.6 per 100 general practice encounters.1 In the hospital setting, children and young adults account for most of the hospital separations for acute URI including the specific discharge diagnoses obstructive laryngitis (croup) and tonsillitis.2 However, there is a paucity of data relating to the frequency of presentation to hospital emergency departments (EDs) and subsequent re-presentation for these conditions. The aim of the present study was to use ED data linked to hospital morbidity, death and microbiology data to describe the epidemiological and other characteristics of ED presentations diagnosed with acute URI.

Methods

Study design and data source

We conducted a retrospective study of all patients given an ED diagnosis of acute URI from July 2000 to July 2003 at any of the four metropolitan teaching hospitals in Perth, Western Australia. Collectively, these hospitals serve a population of around 1.5 million people.

ED, hospital morbidity and mortality records were patient linked by the Western Australian Data Linkage Unit using probabilistic matching.3"5 The data linkage process allows records from individual contributing datasets to be identified as belonging to the same patient.

The ED and morbidity records relating to the same episode of care were then matched by comparing ED arrival and discharge times to hospital admission times. Bacterial culture results were matched to the ED records on the basis of hospital, medical record number and dates of specimen collection, ED arrival, ED discharge and hospital separation. Virology and microscopy data were not available for linkage.

The cohort was selected based on the International Classification of Diseases codes for acute URI, and included Tenth Revision Australian Modification (ICD-IO-AM) codes JOO to J06 and the equivalent Ninth Revision (ICD-9) codes 460 to 465. A change in use of revision occurred in one hospital during the study period, hence the need to use both volumes.

Ethics

Ethics approval for the study was received from the Western Australian Confidentiality of Health Information Committee and the Human Research Ethics Committees of The University of Western Australia and of each of the study hospitals.

Data analysis

Descriptive statistical analyses were performed using the SPSS software version 12 (SPSS Inc, Chicago, 111, USA) and logistic regression performed using Intercooled STATA 8 (StataCorp LP, College Station, Tex, USA). …

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