老年糖尿病發燒的病人在急診之臨床表現

Handling Geriatric Patients with Diabetes Mellitus and Fever in the Emergency Department

在急診評估老年糖尿病病人的發燒是非常花時間且困難的，然而，目前鮮少有這方面的研究供我們參考．因此我們在2010年6月1日至2010年7月21日期間，在一間醫學中心急診室收集老年糖尿病且發燒的病人來做這個研究．發燒的定義為耳溫大於等於37.2°C或比基礎體溫上升超過或等於1.3°C．我們以30天時有無死亡作為主要終點．最後總共有96個病人納入我們的研究，最常見發燒的原因是尿路感染、下呼吸道感染、發燒無明顯原因、上呼吸道感染及腹內感染．年齡跟死亡沒有顯著相關，格拉斯哥昏迷量表小於等於8分是死亡的獨立預測因子．整體死亡率是8.3%，大部分死亡的原因是敗血症．此研究結果可供臨床醫師治療此類病人時重要參考。

Evaluating geriatric patients with diabetes and fever is time-consuming and challenging in the emergency department (ED), and the literature does not contain much guidance regarding successful patient management strategies. Geriatric patients with diabetes mellitus who visited our hospital’s ED between June 1 and July 21, 2010, were automatically enrolled when they met one of the following fever-related criteria: a tympanic temperature ≥ 37.2°C or a baseline temperature elevated ≥ 1.3°C. We used 30-day mortality as the primary endpoint. Ninety-six patients were enrolled. The most common causes of fever were urinary tract infection, lower respiratory tract infection, fever without significant focus, upper respiratory tract infection, and intra-abdominal infection. A Glasgow Coma Scale (GCS) score £ 8, but not age, was independently associated with 30-day mortality. The 30-day mortality rate was 8.3%, and most of the patients died from sepsis. These findings may help physicians make decisions about geriatric patients with fever.