Epidemiology, treatment, and economics of patients presenting to the emergency department for skin and soft tissue infections.
Epidemiology, treatment, and economics of patients presenting to the emergency department for skin and soft tissue infections.
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DOI：
10.1080/21548331.2017.1279519
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发表时间：
2017-02-01
影响因子：
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通讯作者：
Nailor, Michael D
中科院分区：
文献类型：
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作者：
Linder, Kristin E;Nicolau, David P;Nailor, Michael D
目标：皮肤和软组织感染（SSTI）是最常见的细菌性疾病之一，是一个重大的疾病负担。本研究的目的是描述对急诊室 (ED) 就诊的 SSTI 患者的现实管理。方法：这是一项回顾性队列研究。根据 ICD-9 代码确定初步诊断为 SSTI 的成年患者根据指数呈现进行长达 30 天的评估。纳入前 30 天审查记录，以确保记录住院指数。对于重复访问，30 天后实施类似的策略。 结果：在筛选的 446 例遭遇中，纳入了 357 例； 106 例（29.7%）入院，251 例（70.3%）在门诊接受治疗。在查尔森合并症指数 (CCI) 评分为 2 或更高的患者中，60.9% 接受住院治疗，而 CCI 评分为 1 和 0 的患者入院率分别为 30.1% 和 14.1%。住院患者的平均住院时间（LOS）为7.3±7.1天。住院患者和门诊患者之间，总体就诊率 22.6% 和 28.3% (p>0.05) 或 SSTI 相关再就诊率 10.4% 和 15.1% (p>0.05) 没有检测到差异。伤口/脓肿培养中发现的最常见的革兰氏阳性菌是 MSSA（37.1% 住院患者）和 MRSA（66.7% 门诊患者）。住院患者的平均总护理成本为 13,313 美元，门诊患者的平均总护理成本为 413 美元。结论：本分析确定了改进 SSTI 护理流程的机会，旨在减少 LOS、减少再入院并最终减轻医疗保健系统的负担。
OBJECTIVES: Skin and soft tissue infections (SSTIs) are among the most common bacterial diseases and represent a significant disease burden. The purpose of this study was to describe the real-world management of patients with SSTIs presenting to the emergency department (ED).METHODS: This is a retrospective cohort study. Adult patients identified with a primary diagnosis of SSTI determined by ICD-9 codes were assessed from index presentation for up to 30days. Records were reviewed 30days prior to inclusion to ensure index hospitalization was captured. For recurrent visits, a similar strategy was implemented 30days afterward.RESULTS: Of 446 encounters screened, 357 were included; 106 (29.7%) were admitted to the hospital and 251 (70.3%) were treated outpatient. Of patients with a Charlson Comorbidity Index (CCI) score two or greater, 60.9% were treated as inpatients, whereas admission rates were 30.1% and 14.1% for patients with a CCI score of one and zero, respectively. Inpatients had an average length of stay (LOS) of 7.3±7.1days. No difference was detected in overall re-presentation to the facility 22.6% and 28.3% (p>0.05) or in SSTI related re-presentation 10.4% and 15.1% (p>0.05) between inpatient and outpatients. The most common gram-positive organisms identified on wound/abscess culture were MSSA (37.1% inpatients) and MRSA (66.7% outpatients). Mean total cost of care was $13,313 for inpatients and $413 for outpatients.CONCLUSION: This analysis identifies opportunities to improve processes of care for SSTIs with the aim of decreasing LOS, reducing readmissions, and ultimately decreasing burden on the healthcare system.