High Risk Clinical Characteristics of Pyogenic Spinal Infection Presenting to a Community Emergency Department
59th MDW San Antonio United States
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Objective To identify clinical characteristics associated with pyogenic spinal infection and describe the prevalence of these characteristics among adults presenting to a community emergency department ED with neck or back pain. Methods We conducted a prospective cohort study in a single community ED 2004 to 2018 of adults who presented to the ED with neck or back pain in whom the ED provider had a clinical concern for pyogenic spinal infection. Phase 1 of the study 2004- March 2010 included patients with and without pyogenic spinal infection. Phase 2 March 2010-2018 included only patients with pyogenic spinal infection. We performed univariate and multivariate analyses for association of clinical characteristics with pyogenic spinal infection. We summarized the clinical presentation of spinal epidural abscess SEA versus non-SEA pyogenic spinal infection. Results We enrolled 232 patients, 89 of whom had pyogenic spinal infection. The median age was 55 years interquartile range 41 to 66 years and 102 patients 45.7 percent were male. Study phase 1 analyzed 174 patients 40 with pyogenic spinal infection, and clinical characteristics with the strongest association with pyogenic spinal infection on multivariate analysis were recent soft tissue infection or bacteremia odds ratio OR 13.8, 95 percent confidence interval CI 3.5 to 54.3, male sex OR 6.2, 95 percent CI 2.9 to 13.2, history of fever in the ED or prior to arrival OR 4.9, 95 percent CI 2.2 to 10.6, and diabetes OR 2.2, 95 percent CI 1.0 to 4.7. Among patients with SEA n61, 49 80.3 percent had at least one historical risk factor, 12 19.7 percent had fever in the ED, and 8 13.1 percent had a history of intravenous drug use. Conclusion In this prospective cohort of adults with pyogenic spinal infections presenting to a community ED, male sex, fever, and recent soft tissue infection or bacteremia had the strongest association with pyogenic spinal infection.
- Medicine and Medical Research