What are common Outpatient Department (OPD) cases?

Common Outpatient Department (OPD) Cases

Respiratory Tract Infections

Respiratory tract infections, particularly lower respiratory tract infections and COPD exacerbations, represent a major proportion of OPD presentations. 1

COPD Exacerbations

• Patients present with worsening dyspnea, increased cough, and changes in sputum volume or purulence 1
• Criteria for outpatient management include: FEV1 >50%, adequate response to initial treatment within 12 hours, ability to eat and sleep, stable mental status, and adequate home support 1
• Hospitalization is required when patients show marked increase in dyspnea, worsening hypoxemia or hypercapnia, inability to care for themselves, or presence of high-risk comorbidities including pneumonia, cardiac arrhythmia, congestive heart failure, diabetes mellitus, or renal/liver failure 1

Community-Acquired Pneumonia

• Lower respiratory tract infections requiring outpatient parenteral antimicrobial therapy (OPAT) are common 1
• Patients with slowly resolving or non-responding pneumonia require re-investigation based on clinical condition and risk factors 1

Infectious Diseases Suitable for Outpatient Management

Multiple infectious conditions can be effectively managed in the outpatient setting with appropriate patient selection and monitoring. 1

Soft Tissue and Bone Infections

• Cellulitis and wound infections are frequently managed as outpatients 1
• Osteomyelitis can be treated with OPAT in selected patients with adequate vascular access and home support 1
• Septic arthritis or bursitis may be managed outpatient after initial stabilization 1

Urinary Tract Infections

• Complicated urinary tract infections requiring parenteral therapy can be managed as outpatients 1
• Pyelonephritis in stable patients without sepsis is suitable for outpatient treatment 1

Thromboembolic Disease

Pulmonary embolism represents a significant proportion of OPD cases, with validated risk stratification tools identifying 30-50% of patients as suitable for outpatient management. 1

Risk Stratification for Outpatient PE Management

• Patients with sPESI score of 0 or PESI class I/II, absence of RV dysfunction on imaging, and normal cardiac biomarkers (BNP <100 pg/mL, hsTnT <14 pg/mL, or hsTnI <0.012 ng/mL) have 0-1% risk of 30-day adverse events 1
• Exclusion criteria include: hemodynamic instability, active bleeding, severe renal/hepatic impairment, recent stroke, pregnancy complications, or inadequate home support 1
• Patients require verbal and written discharge instructions, designated contact points for complications, and formal review within the first week 1

Musculoskeletal Disorders

Crystal Arthropathies

• Acute CPP crystal arthritis (pseudogout) presents with acute joint pain and swelling 1
• Treatment includes NSAIDs with gastro-protective agents, colchicine 0.5-0.6 mg twice daily, or intra-articular corticosteroid injection 1
• Prophylaxis with low-dose colchicine (0.6 mg twice daily) reduces attack frequency from 3.2 to 1.0 episodes per year 1

Diabetes-Related Musculoskeletal Complications

• Musculoskeletal disorders occur with increased frequency in diabetic patients, correlating with disease duration and age 2
• Common presentations include adhesive capsulitis, carpal tunnel syndrome, and Dupuytren's contracture 2

Medically Unexplained Symptoms

A substantial proportion of OPD consultations involve bodily symptoms that do not meet diagnostic criteria for specific diseases. 3

Prognostic Classification

• Self-limiting symptoms: Recent onset, single system involvement, responding to reassurance 3
• Recurrent and persistent symptoms: Multiple symptoms, multiple body systems, occurring multiple times—these patients have reduced quality of life and risk iatrogenic harm 3
• Symptom disorders: Severe functional impairment requiring specialist intervention 3

COVID-19 and Respiratory Symptoms

Diagnostic Considerations

• Fever, myalgia or arthralgia, fatigue, and headache serve as red flags for COVID-19 with specificity >90% and positive likelihood ratios ≥5 4
• Cough, sore throat, fever, myalgia, fatigue, and headache have sensitivity ≥50% for COVID-19 4
• Individual signs and symptoms have poor diagnostic accuracy; combinations and clinical context are essential 4

High-Risk Comorbidities

• Hypertension (prevalence 20-44% in COVID-19 patients) and diabetes (8-23%) are the most common comorbidities 5, 6
• Cardiovascular disease increases odds of severe disease by 3.42-fold 6
• Respiratory system disease and hypertension increase severe disease risk by 2.46-fold and 2.36-fold respectively 6

Critical Pitfalls in OPD Management

• Never discharge COPD exacerbation patients without assessing for high-risk comorbidities, response to initial treatment, and adequacy of home support 1
• Avoid selecting PE patients for outpatient management based solely on clinical gestalt; always use validated risk scores (sPESI, PESI, or Hestia criteria) 1
• Do not assume single-system pathology in patients with multiple comorbidities; cardiac and respiratory complications frequently coexist 7, 8
• Recognize that medically unexplained symptoms with multiple system involvement and chronicity require early intervention to prevent disability and excessive healthcare utilization 3