Characteristics of Skin, Soft Tissue Infections Requiring High-Level Care
Researchers found that there is little evidence that the increased admission rates improve outcomes, particularly with the availability of various means to administer parenteral antibiotics to outpati
Data published in the Annals of Emergency Medicine identified a limited number of simple clinical characteristics that appear to identify skin and soft tissue infections that require high-level inpatient services.
A noncurrent review of existing records identified emergency department patients treated for skin and soft tissue infections. The presence or absence of select criteria was recorded for each case, along with whether the patient needed high-level care (defined as intensive care unit admission, operating room surgical intervention, or death as the primary outcome). Recursive partitioning was then applied to identify the principal criteria associated with high-level care.
Of 2923 patients identified via records review, 84 experienced high-level events. The variables associated with these events were abnormal computed tomography, magnetic resonance imaging, or ultrasonographic imaging result; systemic inflammatory response syndrome; history of diabetes; previous infection at the same location; age >65 years; and an infection involving the hand. Each patient receiving high-level care had 1 or more of these variables present.
The study investigators hypothesized that although hospitalization is likely to be of benefit for those in need of high-level services and those with specific concurrent conditions, it is likely of little benefit to those with mild systemic responses or those receiving parenteral antibiotic therapies. However, they noted that their research does not address "the unquantifiable benefit from observation and other supportive care that is inherent with hospitalization." For example, inpatients are likely to demonstrate better medication adherence and hydration. The study investigators also acknowledged that hospitalization may not be the most cost-effective method of providing this supportive care.
The study authors concluded that it is possible, using a limited set of criteria, to identify those skin and soft tissue infections that require high-level inpatient care, but future work is still needed to determine whether it is safe to discharge patients not exhibiting these criteria.
Mower WR, Kadera SP, Rodriguez AD, et al. Identification of clinical characteristics associated with high-level care among patients with skin and soft tissue infections [published online November 9, 2018]. Ann Emerg Med. doi: 10.1016/j.annemergmed.2018.09.020.