High use of antibiotics in elderly patients at discharge after hospitalization for acute abdominal pain
- 280 Downloads
KeywordsMortality Rate Elderly Patient Abdominal Pain Young Patient Emergency Medicine
8% of the annual discharges at our hospital of Nykøbing-Falster (NFS) are registered as acute abdominal pain. A former study in our department based on national data has demonstrated a high use of pain-killers, antibiotics, and antacids in these patients. We want to investigate if there is a difference in the drug consumption before and after hospitalization due to unspecific abdominal pain, in patients aged 18-60 compared to patients aged 80+.
A retrospective audit study was performed in a group of younger patients (20-60 years) and a group of elderly (80+ years) with unresolved abdominal pain before and after admittance to NFS in 2012. Patients were included with a discharge code of acute abdominal pain without any explanation (ICD-10 code R10). We assessed the use of medication on the admission day and new drugs prescribed at discharge supplemented with duration of hospitalization, frequency of re-admittance within 30 days, 30 days mortality rate, and correct disease-coding. The following groups of drugs were studied; antibiotics, painkillers, and antacids including H2-antagonists. In 16 of 74 cases in the elderly and 3 of 74 cases in the young, we found a specific diagnosis and their data was excluded.
The study included 71 patients (20-60 years), mean age 37 years, and 58 patients (80-99 years) mean age 85 years. The 80+ year patients versus the younger had a longer length of stay, at 4.67 days (1-65) versus 2 days (1-12), readmission rate was higher at 28% versus 10.8% and mortality rate was 19% versus 0%. In general, the elderly were prescribed more medication at arrival and increased at discharge compared to the younger. The elderly had a significantly increase in new antibiotics from 7% at admission to 28% at discharge.
We found that the elderly patients had a very high mortality rate. They were discharged without explanation for their abdominal pain, but had prescribed more new symptomatic medication as painkillers and antacids compared to the younger. As a new finding, we showed that the elderly in 28% of the cases were treated with antibiotics at discharge. Whether this is a bias to wrong disease coding or to symptomatic use of antibiotics with weak indications need further investigation.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.