Treatment of Skin and Soft Tissue Infections in a Pediatric Observation Unit

Abstract

Our findings suggest that successful OU treatment is possible in a large group of patients needing hospitalization for SSTIs. Consideration of infection location may assist the emergency department clinician in determining the most appropriate unit for admission.

Skin and soft tissue infection management failure in the emergency department observation unit: a systematic review

“…The most commonly significant risk factor was fever, which was significant after multivariable logistical regression analysis in studies by Volz et al 6 and Sabbaj et al ,14 as well as being significant on univariate analysis in Lane et al 9…”

Failure of Emergency Department Observation Unit Treatment for Skin and Soft Tissue Infections

“…therapy for cellulitis lasting < 23 h in children was associated with a twofold increase in return visits and re-admission, suggesting that this condition may not be optimal for short stay or observation therapy (14,15). A single pediatric ED study by Lane et al specifically evaluated treatment of SSTI in an OU (30). Using discharge from observation within 26 h as their criterion for successful treatment, a failure rate of 30% was determined for SSTI (30).…”

“…A single pediatric ED study by Lane et al specifically evaluated treatment of SSTI in an OU (30). Using discharge from observation within 26 h as their criterion for successful treatment, a failure rate of 30% was determined for SSTI (30). Notably, 40% of their study population was comprised of dental infections and facial infections, both of which had the highest success rate of all body sites in their study.…”

“…Restriction to usual cellulitis and skin abscesses by Lane et al, as in our study, would result in an even greater OU failure rate. Additionally, the authors did not evaluate temperature on ED presentation, though children with serum markers of systemic inflammation, such as elevated C-reactive protein and erythrocyte sedimentation rate, had a greater than twofold association with failure of OU treatment (30). Measurement of serum studies is not recommended for routine management of SSTI in the inpatient or outpatient setting; however, these findings support that systemic response, such as fever, may be a marker for increased risk of OU treatment failure (31,32).…”

“…Ours is a single-center study, and we recognize that not all institutions use OUs in the same manner. Our institution did not use the OU to determine the need for subsequent hospitalization; rather, it focused on treatment of conditions that are straightforward and have a very high probability of discharge within 24 h. Therefore, our definition of OU treatment failure may not be generalizable, though our assessments of OU failure were similar to prior studies (22,29,30). In addition, although we found a significant relationship between OU failure and performance of an ultrasound, only 34 (17.6%) of our study population had this test performed, limiting our ability to fully assess the contribution to treatment failure.…”