Skin and Soft Tissue Infections in the Emergency Department

<p><strong>Background/Purpose</strong>: Skin and soft tissue infections (SSTI) represent a diverse group of infections varying in clinical presentation and degree of severity. The International Classification of Diseases codes for patients presenting with cellulitis or abscess account for $5.5 billion in annual health care costs and 1.4% of all hospital admissions nationally. Data are needed to inform admission and management decisions. The purpose of this study is to examine relationships among sociodemographic, physical examination findings, and treatment modality and management in patients with SSTIs.</p> <p><strong>Theoretical/Conceptual Framework</strong>: Web of Causation Theoretical Framework explores multiple causative factors treated with equal prominence, thus facilitating a non- linear evaluative approach for an understanding of the etiology and patient specific characteristics as influential factors to any process disease and its management.</p> <p><strong>Method: </strong>Retrospective, cohort design. Data were extracted from the electronic health records of a convenience sample (N = 857), aged 18 and older diagnosed with an upper or lower extremity SSTI, receiving Emergency Department services at a high-volume Southern California rural ED, January 1, 2016 through December 31, 2018. Descriptive and inferential analyses.</p> <p><strong>Results: </strong>Average age 45.65 + 17.17 years, 67.1% male, 75% Hispanic origin. Final diagnosis: 56.9% cellulitis, 40.1% abscess, 2.2% both cellulitis and abscess, 0.7% other SSTI; 97.7% discharged home; 2.3% admitted; 8.8% returned within 24 hours of discharge. Age was significantly different for patients’ final diagnosis, <em>Welch's F</em>(3, 20) = 24.30, <em>p</em> < .001; younger age for abscess (<em>M</em> = 40.69, SD = 13.61) compared to cellulitis (<em>M</em> = 49.60, <em>SD </em>= 18.55); abscess and cellulitis (<em>M</em> = 35.00, <em>SD</em> = 11.00) compared to cellulitis (<em>M</em> = 49.60, <em>SD</em> = 18.55) and final disposition <em>F</em>(1, 855) = 6.78, <em>p</em> = .009; older age significantly increased for those admitted to the hospital (<em>M</em> = 55.50, SD = 13.95) compared to discharged home (<em>M</em> = 45.42, <em>SD </em>= 17.17).</p> <p><strong>Conclusions and Implications:</strong> Age and heart rate should be included when evaluating and treating a patient with SSTIs. Study findings<strong> </strong>within this rural community support the consideration and incorporation of sociodemographic factors and social determinents of health as central for standardized care within all communities.</p>

Name thesis:degree_name

PhD Nursing

Level thesis:degree_level

Dissertation: Open Access

Discipline thesis:degree_discipline

Nursing

Year dc:date.available

2020

Author dc:creator

• Martinez, Nicole

• emergency
• abscess
• cellulitis
• skin and soft tissue infections
• Dermatology
• Emergency Medicine
• Infectious Disease
• Nursing

Repository record dc:identifier

https://digital.sandiego.edu/dissertations/167

OAI identifier oai:identifier

oai:digital.sandiego.edu:dissertations-1169