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Acute gout management during hospitalization: a need for a protocol.
S R Gnanenthiran1, G M Hassett, K A Gibson
1South Western Sydney Clinical School, University of New South Wales, Australia.
Internal Medicine Journal
|January 12, 2010
Summary
Hospitalized patients with acute gout often receive suboptimal treatment, with delays and inappropriate medication use. Establishing hospital-wide protocols is recommended to improve care for acute gout episodes.
Area of Science:
- Internal Medicine
- Rheumatology
- Clinical Pharmacology
Background:
- Acute gout management during hospitalization is critical for patient outcomes.
- Current practices may lead to suboptimal care and delayed treatment.
- Variability in management necessitates a review of hospital protocols.
Purpose of the Study:
- To systematically review the management of acute gout during hospitalization.
- To identify areas of suboptimal care and delays in treatment.
- To provide recommendations for improved hospital-wide management protocols.
Main Methods:
- A retrospective case-file review of acute gout episodes over a 20-month period in a tertiary hospital.
- Analysis of patient demographics, medications, treatment delays, and consultation patterns.
- Assessment of pharmacological management appropriateness and patient outcomes.
Main Results:
- 134 acute gout episodes were identified, with most occurring in non-rheumatology units.
- 25% of patients received inappropriate pharmacological management, including medication cessation, delayed treatment, and incorrect dosing.
- NSAIDs were inappropriately prescribed in patients with renal impairment; colchicine dosing correlated with diarrhea.
- Rheumatology consultation was associated with more frequent investigations, combination therapy, and better symptomatic relief.
Conclusions:
- Hospitalized patients with acute gout frequently experience suboptimal investigations and treatment.
- A significant percentage of patients receive inappropriate care, highlighting the need for standardized protocols.
- Implementation of a hospital-wide protocol is recommended to guide investigations, treatment, and follow-up for acute gout.
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