The burden of bone, native joint and soft tissue infections on orthopaedic emergency referrals in a city hospital

Abstract

INTRODUCTION Bone, native joint and soft tissue infections are frequently referred to orthopaedic units although their volume as a proportion of the total emergency workload has not been reported previously. Geographic and socioeconomic variation may influence their presentation. The aim of this study was to quantify the burden of such infections on the orthopaedic department in an inner city hospital, determine patient demographics and associated risk factors, and review our current utilisation of specialist services. METHODS All cases involving bone, native joint and soft tissue infections admitted under or referred to the orthopaedic team throughout 2012 were reviewed retrospectively. Prosthetic joint infections were excluded. RESULTS Almost 15% of emergency admissions and referrals were associated with bone, native joint or soft tissue infection or suspected infection. The cohort consisted of 169 patients with a mean age of 43 years (range: 1-91 years). The most common diagnosis was cellulitis/other soft tissue infection and the mean length of stay was 13 days. Two-thirds of patients (n=112, 66%) underwent an operation. Fifteen per cent of patients were carrying at least one blood borne virus, eleven per cent were alcohol dependent, fifteen per cent were using or had been using intravenous drugs and nine per cent were homeless or vulnerably housed. CONCLUSIONS This study has shown that a significant number of patients are admitted for orthopaedic care as a result of infection. These patients are relatively young, with multiple complex medical and social co-morbidities, and a long length of stay.

Musculoskeletal Injuries and Conditions Among Homeless Patients

“…Of the 29 studies screened, 21 studies (72%) were conducted in the United States, two (7%) in the United Kingdom, 6 , 19 two (7%) in Canada, 31 , 38 and one each in Japan, 34 Amsterdam, 10 Nepal, 35 and the Philippines. 36 Fourteen of the 29 studies (48%) collected data on homeless patients from hospitals and ED settings.…”

“… 36 Fourteen of the 29 studies (48%) collected data on homeless patients from hospitals and ED settings. 3 , 6 , 14 , 15 , 19 , 20 , 22 , 25 , 26 , 28 , 29 , 32 , 37 , 38 Shelters, 4 , 10 , 16 , 30 , 31 , 34 community health clinics, 18 , 23 , 27 , 36 and field surveys 17 , 24 , 33 were also used. Of the six prospective studies included in the analysis, two recruited homeless individuals from shelters, 10 , 23 two recruited those directly from the community through field surveys, 24 , 36 one recruited those from a community health clinic, 18 and one recruited self-identified homeless individuals from a hospital ED.…”

“…Field et al 35 and Howell et al 10 found that within their samples, septic arthritis and osteomyelitis were common diagnoses, and 9% of homeless individuals had a suspected bone or joint infection. 6 , 19 In 2018, Mosites et al 29 examined an outbreak of group A streptococcal cases in Alaska and found that 81% of infections occurred in homeless individuals, 23% of whom presented with necrotizing fasciitis. Young et al 37 examined the risk of methicillin-resistant Staphylococcus aureus soft-tissue infections and found that homeless patients had 1.4 higher odds for S aureus soft-tissue infection compared with patients with stable living situations ( P = 0.04).…”

“…However, this study only accounted for orthopaedic trauma and not for other musculoskeletal injuries such as arthritis, 4 podiatry-related issues including peripheral vascular disease and amputation, 5 or advanced osteoarthritis of the hip and knee. 6 In 1990, Gelberg et al reported that in a study comparing homeless and nonhomeless patients at a free clinic, homeless patients reported a higher degree of foot pain than nonhomeless patients. 4 , 7 …”

The Value of Ortho-ID Teams in Treating Bone and Joint Infections

“…Studies in different countries and time periods have attempted to capture the volume of ID consultations for musculoskeletal infections in various ways -these have accounted from 7% up to 30% of all ID consultations [10][11][12] and a consultation rate of 7.6 per 100 admissions arising from the orthopaedics department in one Israeli study [10]. BJIs are often the most common diagnosis for OPAT, as described in a Singaporean study (osteomyelitis being the most common indication, comprising 15% of the caseload) [13] and Dutch study (BJI comprised 38%) [14], with another UK study finding that 15% of emergency admissions and referrals (excluding PJI) were associated with BJIs or soft tissue infection [15].…”