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High use of antibiotics in elderly patients at discharge after hospitalization for acute abdominal pain

Background

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+.

Methods

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.

Results

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.

Conclusion

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.

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Correspondence to Jakob S Jensen.

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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.

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Jensen, J.S., Ipsen, H.L. & Jørsboe, H. High use of antibiotics in elderly patients at discharge after hospitalization for acute abdominal pain. Scand J Trauma Resusc Emerg Med 23 (Suppl 1), A25 (2015). https://0-doi-org.brum.beds.ac.uk/10.1186/1757-7241-23-S1-A25

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  • DOI: https://0-doi-org.brum.beds.ac.uk/10.1186/1757-7241-23-S1-A25

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