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Failure of Emergency Department Observation Unit Treatment for Skin and Soft Tissue Infections.
J Emerg Med. 2015 Dec; 49(6):855-63.JE

Abstract

BACKGROUND

The effectiveness of observation unit (OU) management of skin and soft tissue infections (SSTI) has not been fully evaluated.

OBJECTIVE

This study was performed to determine the rate and risk factors.

METHODS

Retrospective cohort study of children ages 2 months to 18 years admitted to the OU for an SSTI between 2007 and 2010 from a pediatric emergency department (ED). Failure of OU therapy was defined as subsequent inpatient ward admission, re-admission after discharge from OU, initial or repeat incision and drainage after OU admission, or change in antibiotic therapy. Demographic, clinical, and lesion characteristics were collected. Comparative analyses were conducted to determine factors associated with OU failure; prolonged OU admission, defined as length of stay ≥ 36 h was evaluated.

RESULTS

One hundred ninety-two (63.2%) of 304 subjects with SSTI were eligible; mean age was 6.2 ± 5.3 years, and 52% were male. Fever (≥38°C) in the ED was present for 77 (40%). Most lesions were skin abscesses (53%) and were located on the lower extremity (36%) and buttock/genitourinary (21%). OU treatment failure occurred in 22% (95% confidence interval [CI] 16.5-28.3), primarily due to inpatient admission. Fever on ED presentation was significantly associated with OU failure (odds ratio 2.02; 95% CI 1.02-4.02). Demographics, body site, presence of abscess, and methicillin-resistant Staphylococcus aureus were not associated with OU failure. Prolonged OU admission occurred in 18 subjects (9.4%).

CONCLUSION

SSTI can be successfully treated in the OU, though febrile children with SSTI are at risk for OU treatment failure and should be considered for inpatient admission.

Authors+Show Affiliations

Department of Pediatrics, Section of Emergency Medicine, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado.Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts.Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25937477

Citation

Mistry, Rakesh D., et al. "Failure of Emergency Department Observation Unit Treatment for Skin and Soft Tissue Infections." The Journal of Emergency Medicine, vol. 49, no. 6, 2015, pp. 855-63.
Mistry RD, Hirsch AW, Woodford AL, et al. Failure of Emergency Department Observation Unit Treatment for Skin and Soft Tissue Infections. J Emerg Med. 2015;49(6):855-63.
Mistry, R. D., Hirsch, A. W., Woodford, A. L., & Lundy, M. (2015). Failure of Emergency Department Observation Unit Treatment for Skin and Soft Tissue Infections. The Journal of Emergency Medicine, 49(6), 855-63. https://doi.org/10.1016/j.jemermed.2015.02.007
Mistry RD, et al. Failure of Emergency Department Observation Unit Treatment for Skin and Soft Tissue Infections. J Emerg Med. 2015;49(6):855-63. PubMed PMID: 25937477.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Failure of Emergency Department Observation Unit Treatment for Skin and Soft Tissue Infections. AU - Mistry,Rakesh D, AU - Hirsch,Alexander W, AU - Woodford,Ashley L, AU - Lundy,Megan, Y1 - 2015/04/30/ PY - 2014/09/19/received PY - 2015/01/13/revised PY - 2015/02/17/accepted PY - 2015/5/5/entrez PY - 2015/5/6/pubmed PY - 2016/9/9/medline KW - emergency medicine KW - observation medicine KW - skin infections SP - 855 EP - 63 JF - The Journal of emergency medicine JO - J Emerg Med VL - 49 IS - 6 N2 - BACKGROUND: The effectiveness of observation unit (OU) management of skin and soft tissue infections (SSTI) has not been fully evaluated. OBJECTIVE: This study was performed to determine the rate and risk factors. METHODS: Retrospective cohort study of children ages 2 months to 18 years admitted to the OU for an SSTI between 2007 and 2010 from a pediatric emergency department (ED). Failure of OU therapy was defined as subsequent inpatient ward admission, re-admission after discharge from OU, initial or repeat incision and drainage after OU admission, or change in antibiotic therapy. Demographic, clinical, and lesion characteristics were collected. Comparative analyses were conducted to determine factors associated with OU failure; prolonged OU admission, defined as length of stay ≥ 36 h was evaluated. RESULTS: One hundred ninety-two (63.2%) of 304 subjects with SSTI were eligible; mean age was 6.2 ± 5.3 years, and 52% were male. Fever (≥38°C) in the ED was present for 77 (40%). Most lesions were skin abscesses (53%) and were located on the lower extremity (36%) and buttock/genitourinary (21%). OU treatment failure occurred in 22% (95% confidence interval [CI] 16.5-28.3), primarily due to inpatient admission. Fever on ED presentation was significantly associated with OU failure (odds ratio 2.02; 95% CI 1.02-4.02). Demographics, body site, presence of abscess, and methicillin-resistant Staphylococcus aureus were not associated with OU failure. Prolonged OU admission occurred in 18 subjects (9.4%). CONCLUSION: SSTI can be successfully treated in the OU, though febrile children with SSTI are at risk for OU treatment failure and should be considered for inpatient admission. SN - 0736-4679 UR - https://www.unboundmedicine.com/medline/citation/25937477/Failure_of_Emergency_Department_Observation_Unit_Treatment_for_Skin_and_Soft_Tissue_Infections_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0736-4679(15)00134-1 DB - PRIME DP - Unbound Medicine ER -