• Changwoo Kang, Kyuseok Kim, Soo Hoon Lee, Chanjong Park, Joonghee Kim, Jae Hyuk Lee, You Hwan Jo, Joong Eui Rhee, Dong Hoon Kim, and Seong Chun Kim.
• Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
• Am J Emerg Med. 2013 Jul 1;31(7):1067-72.

ObjectivesThere are no guidelines regarding the hospitalization of female patients with acute pyelonephritis (APN); therefore, we performed a retrospective analysis to construct a clinical prediction model for hospital admission.MethodsWe conducted a retrospective analysis of a prospective database of women diagnosed as having APN in the emergency department between January 2006 and June 2012. Independent risk factors for admission were determined by multivariable logistic regression analysis in half of the patients in this database. The risk of admission was categorized into 5 groups. The internal and external validations were conducted using the remaining half of the patients and 192 independent patients, respectively.ResultsIndependent risk factors for admission were age of 65 years or greater (odds ratio [OR], 2.62; 1 point), chill (OR, 2.40; 1 point), and the levels of segmented neutrophils greater than 90% (OR, 2.00; 1 point), serum creatinine greater than 1.5 mg/dL (OR, 2.41; 1 point), C-reactive protein greater than 10 mg/dL (OR, 2.37; 1 point), and serum albumin less than 3.3 g/dL (OR, 7.36; 2 points). The admission risk scores consisted of 5 categories, which were very low (0 points; 5.9%), low (1 point; 10.7%), intermediate (2 points; 20.7%), high (3-4 points; 51.9%), and very high (5-7 points; 82.8%) risk, showing an area under the curve of 0.770. The areas under the curve of the internal and external validation cohorts were 0.743 and 0.725, respectively.ConclusionThis model can provide a guideline to determine the admission of women with APN in the emergency department.Copyright © 2013 Elsevier Inc. All rights reserved.

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