White blood cell count and eosinopenia as valuable tools for the diagnosis of bacterial infections in the ED.

Identifying an infection may be difficult in the ED. Neutrophilic leukocytosis is often used in the diagnosis of infection despite its lack of specificity in situations of stress. Our objective was to study the value of each parameter of the WBC count, in particular eosinopenia, to diagnose bacterial infections in the ED. We conducted a retrospective and observational study over a period of 6 months. All patients with one of the following diagnoses were eligible: pneumonia (9.9%), pyelonephritis (26.2%), prostatitis (8.4%), appendicitis (26.2%), cholecystitis (8.4%), and diverticular sigmoiditis (5%). A total of 466 infected patients were included for statistical analysis, and a control group of 466 uninfected patients was randomly selected in the same period of time. All leukocyte count parameters were significantly modified (p < 0.001) in the infected group compared with the control group. Neutrophils and total leukocytes remain the two most suitable parameters for the diagnosis of infections in the ED. Eosinopenia represented the most efficient parameter of the WBC count for the diagnosis of urinary and biliary tract infections. Deep eosinopenia presented a specificity of 94% for the diagnosis of infection. Any modification of the WBC count associated with an elevation of CRP (> 40 mg/L) or fever (> 38.5 °C) showed a high specificity for the diagnosis of infection. A careful analysis of the WBC count remains a valuable tool for the diagnosis of infection in the ED.

Predictors of repeat emergency department visits among patients aged over 65 years.

BACKGROUND: The objective of our study was to evaluate the predictors of repeat visits at Emergency Department (ED) in patients aged ≥ 65 years. METHODS: A prospective observational study was conducted over a month. Inclusion:  patients (age> = 65 year) seen in the ED and leaving the same day. The epidemiological and clinical characteristics at the first visit (index visit (IV)) were collected. The Identification of Senior At Risk (ISAR) score was used to assess our patients. The number of visits (n ≥ 2) to ED within 30 days of the IV was estimated by a phone contact. RESULTS: Inclusion of125 patients. Mean age = 76 +/- 7 years. The sex ratio was 0.85. Twenty five percent of our patients made repeat visits the following period. Univariate analysis identified: age> 75 years, mean ISAR score>2, history of renal failure, ED visit a month prior to the IV, hospitalization in the last 6 months, patients who depend on someone else help at home and those taking more than 3 medications daily. In multivariate analysis, ED visit a month prior to the IV, hospitalization in the last 6 months, and patients who depend on someone else help at home were independent factors of repeat visits to the ED. CONCLUSION:   Efforts to identify patients at high risk of repeat visits to the ED should be made.