Status Quo of Diagnostic Procedures and Treatment of Inpatients with Infective Endocarditis at the Department of General Medicine at a University Hospital in a Suburban City in Japan: A Single-Hospital-Based Retrospective Study

Abstract

Background: Our hospital's department of general medicine is often involved in the diagnosis and treatment of diseases that are considered by other hospitals or other departments in our hospital to be difficult to diagnose correctly.

Objective: The aim of this study was to clarify how patients with infective endocarditis (IE) being admitted to our hospital's department of general medicine were examined and treated and to elucidate their prognosis compared with patients admitted to other departments.

Materials and methods: Inpatients of Saga University Hospital with definite IE from September 2007 to August 2017 were divided into 2 groups: those admitted to the general medicine department (the GM group) and those admitted to other departments (the non-GM group).

Results: Seventy-four patients were included; 17 (23%) were admitted to the general medicine department. In the GM group, the percentage of patients diagnosed with definite or suspected IE was lower (0% vs 32%, p=0.008), as was the rate of patients with echocardiographic findings that fulfilled the major modified Duke's criteria (71% vs 98%, p≤0.001), preadmission. The GM group had higher percentages of patients with back or joint pain (41% vs 9%, p=0.001) and complications, including pyogenic spondylitis (35% vs 2%, p≤0.001), deep-seated abscesses (24% vs 5%, p=0.024), pyogenic arthritis (18% vs 0%, p=0.001), and glomerulonephritis (77% vs 37%, p=0.004) than did the non-GM group. Mortality within 30 days of admission to our hospital (12% vs 14%, p=0.753) and overall in-hospital mortality (12% vs 18%, p=0.570) did not significantly differ.

Conclusion: The general medicine department could have accurately diagnosed IE, given appropriate treatments, and obtained similar prognoses to those of IE patients treated by other departments, including cardiology and cardiovascular surgery, even in patients for whom diagnosing IE was more difficult or who had less typical echocardiographic findings preadmission.

Keywords: cardiology; cardiovascular surgery; echocardiographic findings of infective endocarditis; general medicine; infective endocarditis.

Figure 1

Inclusion criteria. Inpatients diagnosed with IE at Saga University Hospital from September 2007 to August 2017 were identified as per the International Statistical Classification of Diseases and Related Health Problems-10 (ICD-10, code number I-330). Of 110 inpatients, 70 had “definite IE”, and 40 had “probable IE” or “no IE”. Cardiac valvular surgeries were performed on nine of 40 patients with “probable IE” or “no IE”, after which, 4 were diagnosed with “definite IE” according to the modified Duke’s pathological criteria. All 74 patients diagnosed with “definite IE” according to either the modified Duke’s clinical criteria or pathological criteria were enrolled and analyzed in the present study.

Figure 2

Allocation to the general medicine or non-general medicine group. Seventy-four enrolled patients were admitted to 15 different clinical departments; 14 of these patients were admitted to the department of general medicine. Three patients of 60 who were initially admitted to the departments of urology, orthopedics, and cardiology were subsequently moved to the department of general medicine. Seventeen patients (23%) were allocated to the group that had a “history of being admitted to the department of general medicine (GM group).” The remaining 57 patients (77%) were allocated to the group “without a history of being admitted to the department of general medicine (non-GM group)”. Hematology, Pediatrics, Orthopedics, Neurosurgery, Dermatology, Plastic Surgery, and Urology were included in “Other departments”.