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predictive value is high. We wished to see how often a negative

dipstick was clinically helpful in the setting of the nonspecifically

unwell older adult who presented to hospital.


We performed weekly spot audits to evaluate how often a

negative urine dipstick was helpful in the assessment of a non-

specifically unwell older adult (by ruling out UTI)


We reviewed the case records of 216 patients. We found 14

non-specifically unwell older adults. One of these patients had a

negative urine dipstick but was started on antibiotics for a UTI anyway.


Negative urine dipsticks are rarely helpful in the

assessment of nonspecifically unwell older adults. On the one occasion

a urine dipstick was negative, the patient was still treated for a urinary

tract infection.


Community-acquired pneumonia and prognostic score systems in

the very elderly

A.R. Nogueira


, V. Borba


, D. Ferreira


, A. Aragão


, M.T. Veríssimo



A. Carvalho




Faculty of Medicine of the University of Coimbra,



Coimbra Hospital and Universitary Center, Portugal


Community-acquired pneumonia is an important health

problem affecting the very elderly patients, leading to high rates of

morbidity and mortality. Several prognostic scoring systems were

developed aiming to recognize the critical ill patients and help the

decision making process. However its applicability in the very elderly

patients may be limited.


We reviewed the hospital stays at the Internal Medicine

Service ward of a 80 years or older population, diagnosed with

community-acquired pneumonia during the month of January

2014. Their demographics were analyzed and their results at CURB,

SOAR and SCAP risk scores were calculated. We also reviewed other

potential prognostic factors, namely the presence of hypoxemia

(PaO2 < 60 mmHg) and laboratory findings (C-reactive protein and

albumin levels) at the admission. The in-hospital mortality was

recorded, as well as the 6-month, 1-year mortality and the hospital

readmission within 30 days after discharge. A 95% confidence interval

was used.


The medium length of hospital stay of the analyzed popu-

lation (95 patients) was 7 days and the in-hospital mortality rate was

29%. We found a correlation between higher results at the CURB score

and the in-hospital, 6-month and 1-year mortality (p < 0,05). No

significant correlation was founded between the results at the SOAR

and SCAP risk score and the patient

s mortality or 30-day readmission.

We were not able to find any correlation between each of the other

variables (hypoxemia, C-reactive protein and albumin levels) and the

mortality or readmission.


In our study CURB risk score was able to predict


s mortality and hospital readmission. Further adjustments to

the existent risk scores may be needed to improve their sensitivity.


What is the best biomarker to predict infection in elderly standard

care patients?

A. Nunes Ferreira


, M. Camacho


, I. Nogueira Fonseca


, M. Marques



D. Buendia


, T. Rodrigues


, A. Pina


, P. Cantiga Duarte




CHLN, Hospital

Santa Maria, Lisbon, Portugal


Evaluate the best sepsis biomarker in elderly patients

and determine its sensibility and specificity predicting the risk of



Retrospective study, 834 patients admitted to a medical

standard care ward, screened for suffering at least 2 SIRS (Systemic

Inflammatory Response Syndrome) criteria and at least 1 hemoculture

performed. Infection Probability Score (IPS) and sepsis biomarkers

(Leucocytes, C-Reactive Protein (CRP)) were evaluated.


In the final cohort (n = 124), aged 75 ± 15 years, the infection

prevalence was 88%, with 22% bacteremia. The average CRP in infected

patients was higher than in non-infected patients (17.27 mg/dL vs

7.04 mg/dL; p < 0.001), yielding a 0.82 ROC-AUC (CI 95%: 0.72


p < 0.001). The CRP optimal cut-off 8.35 mg/dL presented an 80%

sensibility and 72% specificity predicting infection. IPS and leucocytes

were higher in infected patients but performed sub-optimally in

predicting infection, 0.70 ROC-AUC (CI 95%: 0.53

0.86; p = 0.016),

optimal cut-off 14 (73% sensibility, 64% specificity) for IPS and 0.68

ROC-AUC (CI 95%: 0.53

0.83; p = 0.032), optimal cut-off 10705/



(62% sensibility, 71% specificity) for leucocytes. The performance of

CRP and IPS was more significant in patients under 75 years-old [ROC-

AUC 0.87 for CRP and IPS (p = 0.001)], whereas in patients with at least

75 years, only CRP demonstrated to be useful in predicting infection

0.79 ROC-AUC (CI 95%: 0.66

0.93; p = 0.03).


In standard care ward patients, although CRP should be

privileged in evaluating risk of infection, IPS and leucocytes may also

be considered. However, in elderly patients, only CRP demonstrated

to be useful in predicting infection, which may increase the rationale

to take hemocultures or initiate antibiotics.


Urinary tract infection

a qualitative study exploring the human

factors contributing to misdiagnosis

K. O



, K. Phelps


, E. Regen


, D. Kondova


, S. Conroy





Hospitals of Leicester, UK,


University of Leicester, UK

Urinary problems in older people are common and there is general

agreement regarding their assessment with clear guidelines as to the

use of urinary dipstick testing, including knowledge of asymptomatic

bacteriuria. There is significant variability in practice leading to a

misdiagnosis rate of up to 40% in older patients in hospital. A mapping

review conducted by our group indicated that human factors play a

significant contributory role.

To investigate these human factors we undertook a series of interviews

with nursing and medical clinicians responsible for managing older

people with possible urinary tract infection (UTI) in urgent care

settings. Interviews took place over a three month period and each

lasted approximately 30 minutes. Twenty interviews were conducted

in total with each being recorded and transcribed for analysis using



approach. Analysis was facilitated by the use of the

software package NVivo 1.

Our findings indicate a multi-faceted and complex set of human factor

explanations. Themes included: Time pressures, the need for prompt

diagnosis and the need to rule out life-threatening diagnoses such

as sepsis, often drive inappropriate urinary dipstick testing despite

guidelines to the contrary and often in the absence of appropriate

symptoms. Inexperienced clinicians may interpret dipstick results

incorrectly (eg asymptomatic bacteriuria) and are more likely to arrive

at an incorrect diagnosis. Junior clinicians are also more diagnosis-

driven and less likely to adopt a

watch and wait


An awareness of these human factors will now help tailor an educa-

tional intervention aimed at improving the accuracy of UTI diagnosis.


Internal Medicine and older patients in Emergency Department

P. Oliveira, B. Frutuoso, R. Veríssimo, A. Oliveira.

Internal Medicine

Department, Centro Hospitalar de Vila Nova de Gaia/Espinho

Aging is a problem affecting Emergency Medicine, requiring qualified

staff for special needs of older patients. We intended to understand

what is the paper of internal medicine in the assessment of the older.

We conducted a retrospective, observational study, with a randomized

sample of 14% of total patients admitted during a month in an

Emergency Department (1252/8872 episodes), excluding children

and obstetric patients. We collected demographic data, Manchester

triage, medical specialty involved, the length of stay (LOS) and

destination. Statistical analysis was performed in SPSS ® 23.0 using

qui-square, Mann-Whitney and Kruskal-Wallis tests. In our sample,

53% were female, the average age was 53,9 years, and 32,4% had

65 years. Median LOS in the Emergency Department (ED) was 215

minutes. Median LOS in geriatric patients were higher than younger

Poster presentations / European Geriatric Medicine 7S1 (2016) S29