Identifying patients with cellulitis who are likely to require inpatient admission after a stay in an ED observation unit.

Nov 2012

Volz KA, Canham L, Kaplan E, Sanchez LD, Shapiro NI, Grossman SA.

Source

Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. Electronic address: kvolz@bidmc.harvard.edu.

Abstract

BACKGROUND: 

Emergency department observation units (EDOU) are often used for patients with cellulitis to provide intravenous antibiotics followed by a transition to an oral regimen for discharge. Because institutional regulations typically limit EDOU stays to 24 hours, patients lacking a clinical response within this period will often be subsequently admitted to the hospital for further treatment.

OBJECTIVE:

 The aim of this study was to determine the rate of hospital admission and characteristics predictive of admission in patients with cellulitis who are initially placed in an ED observation unit.

METHODS:

A retrospective cohort study of patients placed into EDOU with a diagnosis of skin infection was conducted. Age, sex, history of diabetes mellitus, immunosuppression, intravenous drug use, location of cellulitis, presence of abscess, laboratory infectious markers, vital signs, and outpatient antibiotic treatment were recorded. The primary outcome was a hospital admission due to failure to respond to treatment within the 24-hour observation time window. Significant variables on univariate analysis were used to create a multivariate analysis, which identified predictive characteristics.

RESULTS:

 Four hundred six patient charts were reviewed, with 377 meeting inclusion criteria; the inpatient admission rate from EDOU was 29.2%. Using logistic regression techniques, we created a model of independent predictors for need of admission after 24 hours: cellulitis of the hand (odds ratio [OR], 2.9; 95% confidence interval [CI], 1.8-4.9), measured temperature higher than 100.4°F (OR, 2.5; 95% CI, 1.1-5.5), and lactate greater than 2 (OR, 3.1; 95% CI, 1.3-7.3) were predictive of failure of ED observation.

CONCLUSIONS:

 Patients with cellulitis placed into ED observation status were more likely to fail an observation trial if they had an objective fever in the ED, an elevated lactate, or a cellulitis that involved the hand.

PubMed

Burden of facial cellulitis: estimates from the Nationwide Emergency Department Sample.

Sept 2012

Kim MK, Allareddy V, Nalliah RP, Kim JE, Allareddy V.

Source

DMD student, Harvard School of Dental Medicine, Boston, MA.

Abstract

OBJECTIVE:

Multitude of maxillofacial infections from odontogenic and nonodontogenic origins can progress to facialcellulitis, which may require an emergency department (ED) visit for appropriate care. The aim of this study was to investigate national prevalence of ED visits attributed primarily to facial cellulitis, to quantify the associated hospital charges, and to identify a cohort of population presenting to the ED with facial cellulitis.

STUDY DESIGN:

The Nationwide Emergency Department Sample (NEDS) for the year 2007, a component database of the health care cost and utilization project was used for this study. All ED visits that had a primary diagnosis of facial cellulitis(ICD-9-CM code 682.0) were selected for analysis. All estimates were projected to national levels using the discharge weight variables.

RESULTS:

In 2007, a total of 302,507 ED visits were attributed primarily to facial cellulitis in the USA. The average age of the patients was 35.0 years. The mean hospital charge for each ED visit was $1,024, with a total charge of $241,541,694. A total of 17.8% of ED visits were admitted into the same hospital for inpatient care, and 78.5% of ED visits were discharged routinely; 67.6% of ED visits occurred on weekdays. Private insurance payers comprised the largest proportion (31.6%).

CONCLUSIONS:

This study highlights the prevalence of hospital-based ED visits primarily due to facial cellulitis in the USA in year 2007, its significant associated hospital resource utilization for treatment, and characteristics of the patient population who are likely to visit a hospital-based ED for treatment of facial cellulitis.

Science Direct