Effect of Dermatology Consultation on Outcomes for Patients With Presumed Cellulitis A Randomized Clinical Trial
Effect of Dermatology Consultation on Outcomes for Patients With Presumed Cellulitis A Randomized Clinical Trial
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DOI：
10.1001/jamadermatol.2017.6196
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发表时间：
2018-05-01
期刊：
影响因子：
10.9
通讯作者：
Kroshinsky, Daniela
中科院分区：
文献类型：
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作者：
Ko, Lauren N.;Garza-Mayers, Anna C.;Kroshinsky, Daniela
每年，蜂窝组织炎导致650000住院治疗，估计在美国花费37亿美元。以往的文献已经证明了蜂窝织炎的高误诊率，这导致不必要的抗生素使用和医疗cost.Objective确定皮肤科会诊是否减少蜂窝织炎患者的住院时间或静脉抗生素治疗时间。这项随机临床试验于2012年10月至2017年1月在一家大型城市三级医院进行，随访1个月。患者被随机分配到对照组，接受标准护理（即由初级医疗团队治疗），或干预组，接受皮肤科咨询。对人口统计学信息和医院病程进行病历审查。假定诊断为蜂窝织炎的住院成人患者符合条件。共筛选了1300例患者，排除1125例，纳入175例。采用统计分析，以确定显着的结果差异之间的2 groups.INTERVENTIONS皮肤科咨询24小时内hospitalization.Main结局和措施住院时间和持续时间的静脉抗生素treatment.Results的175名参与者，70（40%）是女性和105（60%）是男性。平均年龄为58.8岁。两组间的住院时间无统计学差异。静脉注射抗生素治疗的持续时间（
IMPORTANCE Each year, cellulitis leads to 650000 hospital admissions and is estimated to cost $3.7 billion in the United States. Previous literature has demonstrated a high misdiagnosis rate for cellulitis, which results in unnecessary antibiotic use and health care cost.OBJECTIVE To determine whether dermatologic consultation decreases duration of hospital stay or intravenous antibiotic treatment duration in patients with cellulitis.DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was conducted in a large urban tertiary care hospital between October 2012 and January 2017, with 1-month follow-up duration. Patients were randomized to the control group, which received the standard of care (ie, treatment by primary medicine team), or the intervention group, which received dermatology consultation. Medical chart review of demographic information and hospital courses was performed. Adult patients hospitalized with presumed diagnosis of cellulitis were eligible. A total of 1300 patients were screened, 1125 were excluded, and 175 were included. Statistical analysis was employed to identify significant outcome differences between the 2 groups.INTERVENTIONS Dermatology consultation within 24 hours of hospitalization.MAIN OUTCOMES AND MEASURES Length of hospital stay and duration of intravenous antibiotic treatment.RESULTS Of 175 participants, 70 (40%) were women and 105 (60%) were men. The mean age was 58.8 years. Length of hospital stay was not statistically different between the 2 groups. The duration of intravenous antibiotic treatment (