title: Managing Skin and Soft Tissue Infections in the Emergency Department Observation Unit.
abstract: BACKGROUND
  Skin and soft tissue infections (SSTIs) are a common reason for presentation to the emergency department (ED) and account for 3% of ED visits. Patients with a diagnosis of cellulitis requiring intravenous (IV) antibiotics have traditionally been admitted to the hospital. In our institution, these patients are placed in the ED Observation Unit (EDOU) for IV antibiotics.
  
  
  OBJECTIVE
  The purpose of this study is to determine if 3 doses of IV antibiotics are adequate to document clinical improvement in children with uncomplicated SSTI.
  
  
  METHODS
  A prospective cohort study of children aged 3 months to 18 years with uncomplicated SSTI admitted (2009-2013) to the EDOU at a children's hospital for IV antibiotics was conducted.
  
  
  RESULTS
  One hundred six patients (mean age, 68 months) were enrolled; 57% were boys, 53% of patients had cellulitis only and 47% had cellulitis with drained abscesses. There was a significant decrease in pain scores and size of cellulitis from arrival to discharge (P < 0.001 and P < 0.001, respectively). Eighty-three percent of patients were discharged after 3 to 4 doses of antibiotics, and 17% were admitted. The location of the wound, presence of systemic symptoms, and prior use of oral antibiotics did not predict admission in our study.
  
  
  CONCLUSIONS
  The EDOU is a reasonable alternative to inpatient admission in the management of patients with uncomplicated SSTI requiring IV antibiotics.
authors.forename: Shabana
authors.initials: S
authors.lastname: Yusuf
authors.affiliation: Department of Pediatrics, Newborn Center, Houston, TX.
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Hagan
authors.forename: Aderonke O
authors.initials: AO
authors.lastname: Adekunle-Ojo
mesh_terms: D061605:Administration, Intravenous; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002481:Cellulitis / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D000076542:Clinical Observation Units / Q000706:statistics & numerical data*; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010147:Pain Measurement; D010343:Patient Admission / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D011446:Prospective Studies
chemical_list: D000900:Anti-Bacterial Agents