High Risk Clinical Characteristics of Pyogenic Spinal Infection Presenting to a Community Emergency Department

Abstract

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 (n=61), 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.

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Document Details

Document Type
Technical Report
Publication Date
Mar 01, 2019
Accession Number
AD1078872

Entities

People

  • Brit Long
  • Michael D. April
  • Sam Mehta
  • Steve Shroyer
  • William T Davis

Organizations

  • 59th Medical Wing

Tags

Communities of Interest

  • Biomedical

DTIC Thesaurus Topics

  • Abscesses
  • Analgesia
  • Bacteremia
  • Body Regions
  • Bone Diseases
  • Cancer
  • Catheters
  • Data Analysis
  • Health Services
  • Hospitals
  • Infection
  • Information Science
  • Magnetic Resonance
  • Magnetic Resonance Imaging
  • Medical Personnel
  • Multivariate Analysis
  • Pain
  • Risk Factors
  • Soft Tissues
  • Statistical Analysis
  • Test And Evaluation
  • Therapy
  • Wound Infections

Fields of Study

  • Medicine

Readers

  • Marine Propulsion Engineering and Naval Architecture
  • Neurotrauma and Rehabilitation Medicine.
  • Regression Analysis.