title: 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.
authors.affiliation: University College London Hospitals NHS Foundation Trust , UK.
authors.forename: A
authors.initials: A
authors.lastname: Howell
authors.affiliation: University College London Hospitals NHS Foundation Trust , UK.
authors.forename: S
authors.initials: S
authors.lastname: Parker
authors.affiliation: University College London Hospitals NHS Foundation Trust , UK.
authors.forename: K
authors.initials: K
authors.lastname: Tsitskaris
authors.affiliation: University College London Hospitals NHS Foundation Trust , UK.
authors.forename: M J
authors.initials: MJ
authors.lastname: Oddy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001170:Arthritis, Infectious / Q000453:epidemiology / Q000628:therapy*; D001850:Bone Diseases, Infectious / Q000453:epidemiology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D004630:Emergencies / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000639:trends; D006786:Hospitals, Urban / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012017:Referral and Consultation; D018461:Soft Tissue Infections / Q000453:epidemiology / Q000628:therapy*; D055815:Young Adult
keywords: Infection; Infectious diseases; Interdisciplinary communication; Orthopaedics; Psychosocial deprivation; Urban hospitals