Patient Factors That Influence the Decision to Admit or Discharge Patients With Acute Bacterial Skin and Skin Structure Infections (ABSSSIs)
Year: 2015
Type: article
Study design: Observational Study
Abstract: Background. ABSSSIs have resulted in increased hospital admissions over the last decade. It is likely that some admitted patients could be treated as outpatients, potentially reducing hospital complications, use of healthcare resources and increasing patient satisfaction. The objective of this study was to evaluate patient factors that influence the decision to admit ABSSSI patients presenting to the emergency department (ED). Methods. This was a retrospective, observational, multicenter study of adults with ABSSSI presenting to the ED between 1 July 2012 and 30 June 2013, identified by ICD-9 Codes: 681.XX, 682.XX, 686.XX, 958.3X, and 998.5X. Patient disposition (admitted versus not admitted to hospital) was analyzed using univariate logistical regression (SAS, version 9.3). Results. A total of 1541 patients were evaluable from 40 sites. Almost twice as many patients seen in the ED were treated as outpatients versus admitted for ABSSSI (950 versus 592, respectively). Patient characteristics associated with admission versus outpatient treatment after ED visit, respectively, were: higher Charlson indices [OR (95% CI), 1.5 (1.4-1.6)]; diabetes (34 versus 20%), [2.1 (1.7-2.6)] intravenous (IV) drug use history (13 versus 6%), [2.1 (1.4-3.0)]; immunocompromised status (6 versus 2%), [3.5 (2.0-6.0)]; past admission for ABSSSI (24 versus 11%), [2.5 (1.9-3.4)]; having a previous hospital admission within 90 days (29 versus 10%), [3.5 (2.7-4.6)]; prior antibiotic use within 90 days (41 versus 20%), [2.8 (2.2-3.5)]; having a known history of MRSA (16 versus 8%), [2.1 (1.5-2.8)]; initial SIRS criteria on presentation (33 versus 6%) [2.5 (1.8-3.5)]. More patients admitted to the hospital had PICC lines inserted (17 versus 1%), [30.2 (13.1-69.3)]. We also noted that up to 65% of patients did not have a documented follow up visit scheduled. Conclusion. A number of patient characteristics were associated with the decision to hospitalize patients presenting to the ED with ABSSSI. Future study is needed to determine whether a subset of patients admitted to the hospital could be treated safely with oral or long-acting IV antibiotics exclusively as outpatients. Disclosures. S. Doron, Cubist: Speaker's Bureau, Speaker honorarium. Actavis: Speaker's Bureau, Speaker honorarium. Merck: Speaker's Bureau, Speaker honorarium; T. Jenkins, Actavis, Inc: Scientific Advisor, Consulting fee; A. Haynes, Actavis, Inc: Employee and Shareholder, Salary; C. Lopes, Actavis, Inc: Employee and Shareholder, Salary; H. Zhu, Actavis, Inc: Employee and Shareholder, Salary; S. Goldwater, Actavis, Inc: Employee and Shareholder, Salary; R. Owens Jr., Actavis, Inc: Employee and Shareholder, Salary
Source: Open Forum Infectious Diseases
Authors: Shira Doron, Timothy Jenkins, Angela Haynes, Carlos Lopes, Haiyuan Zhu, Shannon Goldwater, Robert Owens
Language: English
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,053
OpenAlex ID: W2261768117