What are the common internal medicine (IM) cases in a general medical ward?

Common Internal Medicine Cases in General Medical Wards

Most Prevalent Conditions

The most common internal medicine cases requiring ward admission globally are community-acquired pneumonia, urinary tract infections, skin and soft tissue infections, acute exacerbations of chronic obstructive pulmonary disease (COPD), and chest pain syndromes. 1

Respiratory Infections

• Community-acquired pneumonia (CAP) represents one of the most frequent admission diagnoses, accounting for approximately 740,000 hospitalizations annually in the United States alone, with significant morbidity and mortality particularly in elderly patients 2
• CAP affects 5-10 million adults annually, with approximately 1.1 million requiring hospitalization 3
• COPD exacerbations are among the priority infections identified for antibiotic stewardship, given their high incidence and contribution to overall antibiotic use 1
• Bronchitis and lower respiratory tract infections frequently require inpatient management, particularly when complicated by underlying comorbidities 1

Urinary Tract Infections

• Both lower and upper urinary tract infections are extremely common ward admissions, particularly in elderly patients and those with comorbidities 1
• Asymptomatic bacteriuria is frequently encountered but should not be treated in most populations, as inappropriate treatment contributes substantially to antimicrobial resistance 1

Cardiovascular Presentations

• Chest pain comprises 5-20% of emergency department visits, with approximately 10-15% ultimately diagnosed with acute myocardial infarction requiring ward or coronary care unit admission 1
• Patients with ongoing chest pain, ischemic ECG changes, positive troponin tests, or hemodynamic abnormalities require specialized coronary care or intensive care unit admission 1
• Unstable angina and non-Q wave infarction represent significant proportions of cardiac admissions to general medical wards 1

Infectious Diseases

• Skin and soft tissue infections, including cellulitis, erysipelas, and complicated surgical site infections, frequently require hospitalization for intravenous antibiotics and surgical intervention 1
• Febrile neutropenia in immunocompromised patients represents a medical emergency requiring immediate ward admission 1
• Sepsis remains a leading cause of admission, with severe cases requiring intensive monitoring and aggressive antimicrobial therapy 1

Gastrointestinal Infections

• Complicated intra-abdominal infections require hospitalization for surgical intervention and broad-spectrum antimicrobial therapy, with morbidity rates of 59% and mortality rates of 21% in emergency surgical cases 1
• Bacterial diarrhea, dysentery (shigellosis), and cholera may require inpatient management depending on severity and hydration status 1

Other Common Admissions

• Bone and joint infections often necessitate prolonged hospitalization for intravenous antibiotics and potential surgical debridement 1
• Meningitis (bacterial) requires immediate hospitalization despite relatively low incidence, given high morbidity and mortality 1
• Acute sinusitis and pharyngitis occasionally require admission when complicated by systemic symptoms or inability to tolerate oral therapy 1

Special Populations

Geriatric Patients

• Elderly patients (≥65 years) in long-term care facilities have particularly high rates of pneumonia, urinary tract infections, and skin infections 1, 4
• Fever may be absent or low-grade in LTCF residents with serious infections, making diagnosis challenging 1
• The most common infections among LTCF residents are urinary tract infections, respiratory infections, skin or soft tissue infections, and gastroenteritis 1

Pediatric Considerations

• Community-acquired pneumonia in children, particularly those with severe acute malnutrition, represents a distinct category requiring specialized management 1

Important Clinical Pitfalls

• Avoid screening for asymptomatic bacteriuria in most populations, as this promotes inappropriate antimicrobial use and resistance development 1
• Do not delay antibiotics in severe pneumonia or sepsis—immediate administration after diagnosis is critical for mortality reduction 4
• Initial assessment in ward settings may be performed by nursing staff rather than physicians, particularly in long-term care facilities, though this practice requires validation 1
• Transfer to acute care facilities should be considered when patients are clinically unstable, critical diagnostics are unavailable, or necessary therapy exceeds facility capacity 1