Document Type : Original Article
Authors
- Samaneh Abiri 1
- Mahdi Foroughian 2
- Hamideh Akbar 3
- Neema John Mehramiz 4
- Naser Hatami 5
- Abdol Ali Ameri 5
- Navid Kalani 6, 7
- Esmaeil Rayat Dost 1
- Saeed Barazandehpour 8
1 Department of Emergency Medicine, Jahrom University of Medical Sciences, Jahrom, Iran
2 Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
3 Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran
4 Department of Psychiatry Neurology, Banner University Medical Center, Tucson, AZ, USA
5 Student Research Committee, Jahrom University of Medical Sciences, Jahrom, Iran
6 6Anesthesiology, Critical Care, and Pain Management Research Center, Jahrom University of Medical Sciences, Jahrom, Iran
7 Research center for social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran
8 Department of Emergency Medicine, Kerman University of Medical Sciences, Kerman, Iran
Abstract
Objective: The purpose of this study was to evaluate a valid model for patients’ admission or discharge from emergency services to improve the health system and reduce costs.
Methods: This study was carried out using a prospective cohort method. The study population was patients with limb cellulitis referring to the emergency department of Peymanieh hospital. In this research, the study participants were separated into two groups based on the duration of hospitalization (hospital stay less than 24 hours or longer than 24 hours), then the patients were again separated into 4 groups based on the classification of the the Clinical Resource Efficiency Support Team (CREST) guideline, which in each of these groups the mean age, gender, and the prevalence of underlying diseases were identified and the final outcome for each group was determined after one week from the visit to the hospital.
Results: Peripheral vascular disease, history of injection drug use, immunodeficiency and congenital immune deficiency had a significant relationship with the rate of hospitalization and recurrence. There was a significant relationship between class 1 disease and hospitalization for less than 24 hours, classes 2 and 3, and hospitalization for more than 24 hours (P < 0.001). There was a significant relationship between grade 1 disease and non-recourse, grade 3 and recurrence within one week after initiation of the treatment (P < 0.001). But there was no relationship between grade 2 and grade 4 and the referral of the patient after treatment.
Conclusion: Corset Scale is a reliable scale for assessing the severity of the disease to determine the process of cellulite treatment for outpatient or hospitalization.
Keywords
Main Subjects
2. Raff AB, Kroshinsky D. Cellulitis: a review. JAMA 2016; 316(3): 325-37. doi:10.1001/jama.2016.8825.
3. Collazos J, de la Fuente B, García A, Gómez H, Menéndez C, Enríquez H, et al. Cellulitis in adult patients: a large, multicenter, observational, prospective study of 606 episodes and analysis of the factors related to the response to treatment. PLoS One 2018; 13(9): e0204036. doi: 10.1371/
journal.pone.0204036.
4. Cranendonk DR, Lavrijsen APM, Prins JM, Wiersinga WJ. Cellulitis: current insights into pathophysiology and clinical management. Neth J Med 2017; 75(9): 366-78.
5. Sadick N. Treatment for cellulite. Int J Womens Dermatol 2019; 5(1): 68-72. doi: 10.1016/j.ijwd.2018.09.002.
6. Gabillot-Carré M, Roujeau JC. Acute bacterial skin infections and cellulitis. Curr Opin Infect Dis 2007; 20(2):118-23. doi: 10.1097/QCO.0b013e32805dfb2d.
7. Rehder PA, Eliezer ET, Lane AT. Perianal cellulitis. Cutaneous group A streptococcal disease. Arch Dermatol 1988; 124(5): 702-4. doi: 10.1001/archderm.1988.01670050046018.
8. Volz KA, Canham L, Kaplan E, Sanchez LD, Shapiro NI, Grossman SA. Identifying patients with cellulitis who are likely to require inpatient admission after a stay in an ED observation unit. Am J Emerg Med 2013; 31(2): 360-4. doi:10.1016/j.ajem.2012.09.005.
9. Ellis Simonsen SM, van Orman ER, Hatch BE, Jones SS, Gren LH, Hegmann KT, et al. Cellulitis incidence in a defined population. Epidemiol Infect 2006; 134(2): 293-9. doi: 10.1017/s095026880500484x.
10. Carratalà J, Rosón B, Fernández-Sabé N, Shaw E, del Rio O, Rivera A, et al. Factors associated with complications and mortality in adult patients hospitalized for infectious cellulitis. Eur J Clin Microbiol Infect Dis 2003; 22(3): 151-7. doi: 10.1007/s10096-003-0902-x.
11. Jenkins TC, Knepper BC, Jason Moore S, Saveli CC, Pawlowski SW, Perlman DM, et al. Comparison of the microbiology and antibiotic treatment among diabetic and nondiabetic patients hospitalized for cellulitis or cutaneous abscess. J Hosp Med 2014; 9(12): 788-94. doi: 10.1002/jhm.2267.
12. Njim T, Aminde LN, Agbor VN, Toukam LD, Kashaf SS, Ohuma EO. Risk factors of lower limb cellulitis in a leveltwo healthcare facility in Cameroon: a case-control study. BMC Infect Dis 2017; 17(1): 418. doi: 10.1186/s12879-017-2519-1.
13. Goldman RD, Dolansky G, Rogovik AL. Predictors for admission of children with periorbital cellulitis presenting to the pediatric emergency department. Pediatr Emerg Care 2008; 24(5): 279-83. doi: 10.1097/PEC.0b013e31816ecb43.
14. Sabbaj A, Jensen B, Browning MA, Ma OJ, Newgard CD. Soft tissue infections and emergency department disposition: predicting the need for inpatient admission. Acad Emerg Med 2009; 16(12): 1290-7. doi: 10.1111/j.1553-2712.2009.00536.x.
15. Abiri S. Emergency Medicine Extremity Cellulitis Referring To the Emergency Rooms of Hazrat Rasoul Akram and Sina Hospitals [dissertation]. Iran University of Medical Sciences; 2014.
16. Mold J. Goal-directed health care: redefining health and health care in the era of value-based care. Cureus 2017; 9(2): e1043. doi: 10.7759/cureus.1043.
17. Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff (Millwood) 2008; 27(3):759-69. doi: 10.1377/hlthaff.27.3.759.
)