Infectious diseases specialist management improves outcomes for outpatients diagnosed with cellulitis in the emergency department: a double cohort study.
Three hospital emergency rooms (ERs) routinely referred all cases of cellulitis requiring outpatient intravenous antibiotics, to a central ER-staffed cellulitis clinic. We performed a retrospective cohort study of all patients seen by the ER clinic in the last 4months preceding a policy change (ER management cohort [ERMC]) (n=149) and all those seen in the first 3months of a new policy of automatic referral to an infectious disease (ID) specialist-supervised cellulitis clinic (ID management cohort [IDMC]) (n=136). Fifty-four (40%) of 136 patients in the IDMC were given an alternative diagnosis (noncellulitis), compared to 16 (11%) of 149 in the ERMC (P<0.0001). Logistic regression-demonstrated rates of disease recurrence were lower in the IDMC than the ERMC (hazard ratio [HR], 0.06; P=0.003), as were rates of hospitalization (HR, 0.11; P=0.01). There was no significant difference in mortality. Automatic ID consultation for cellulitis was beneficial in differentiating mimickers from true cellulitis, reducing recurrence, and preventing hospital admissions.
Department of Medicine, Schulich School of Medicine and Dentistry, London, ON N6A 5C1, Canada. Electronic address: shilpa.jain@medportal.ca.
Shilpa R
SR
Jain
Department of Medicine, Division of Infectious Diseases, Schulich School of Medicine and Dentistry, London, ON N6A 5C1, Canada.
Seyed M
SM
Hosseini-Moghaddam
Department of Medicine, Schulich School of Medicine and Dentistry, London, ON N6A 5C1, Canada.
Philip
P
Dwek
Department of Medicine, Division of Infectious Diseases, Schulich School of Medicine and Dentistry, London, ON N6A 5C1, Canada.
Kaveri
K
Gupta
Department of Medicine, Division of Infectious Diseases, Schulich School of Medicine and Dentistry, London, ON N6A 5C1, Canada.
Sameer
S
Elsayed
Department of Medicine, Division of Infectious Diseases, Schulich School of Medicine and Dentistry, London, ON N6A 5C1, Canada.
Guy W
GW
Thompson
Department of Medicine, Division of Emergency Medicine, Schulich School of Medicine and Dentistry, London, ON N6A 5C1, Canada.
Robert
R
Dagnone
Division of Infectious Diseases, St Joseph's Hospital, London, ON N6A 4V2, Canada.
Kelly
K
Hutt
Department of Medicine, Division of Infectious Diseases, Schulich School of Medicine and Dentistry, London, ON N6A 5C1, Canada.
Michael
M
Silverman
D061605:Administration, Intravenous / Q000379:methods; D000553:Ambulatory Care / Q000379:methods; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002481:Cellulitis / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology*; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization; D006801:Humans; D017053:Infection Control / Q000379:methods; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D012017:Referral and Consultation; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents
Automatic consult policy; Cellulitis