Original ContributionsED management of cellulitis: A review of five urban centers*,**,★
Section snippets
Study setting
The Capital Health Region is located in Edmonton and St. Albert, Alberta, Canada, and serves a population of 870,000 (1996 Census data). At the time of the study, the region had 5 acute care hospitals, all of which accepted emergency patients and were linked by the Capital Health Authority. All 5 sites are urban teaching hospitals staffed by full time emergency physicians who teach both emergency medicine and off-service residents. Two of the centers are tertiary care centers with predominantly
Sample
A total of 416 charts were identified and included in the study; all charts were recovered and reviewed. Of the charts reviewed, excellent agreement between the research assistant and the reviewers was obtained for demographic and event details. Other more important outcomes such as duration of infection (ICC = 0.82), precipitating symptoms (ICC = 0.67), location of infection (k = 1.0), first medication (k = 1.0), and admission (k = 0.74) indicate excellent agreement.
Health service use
A large portion (158
Discussion
This study is the largest study published to date that describes the epidemiology and practice patterns of this common infectious disease problem in a multicenter ED setting. Using accepted methodology, this study described an older population of patients from 5 urban Canadian EDs who had a discharge diagnosis of cellulitis. In this setting, the treatment practice variation is striking, with more than 25 different antibiotic regimens identified as initial treatment options. Although over half
Conclusion
Cellulitis is a common presenting problem in EDs in this region. This study described some of the risk factors and predisposing conditions of cellulitis in a large urban setting and compared its findings to past studies from the ED setting. Although most patients are successfully treated with systemic antibiotics, practice patterns vary widely, indicating that there may be a role for the development of clinical practice guidelines. In addition, the frequency of visits suggest that programs such
Acknowledgements
The authors thank the medical records department for their assistance with chart location. They thank Samantha Barker for data abstraction and also Diane Milette for her invaluable assistance in preparing this manuscript for publication.
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Cited by (0)
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Supported by a salary award (to B.H.R.) from the Canada Research Council as the Chair of Emergency Airway Diseases, Ottawa, ON; the Division of Emergency Medicine, University of Alberta (S.D., B.H.P., B.R.H.) in Edmonton, Alberta, Canada. Dr Kelly has received funding from the Research Excellence Envelope in the Faculty of Medicine and Dentistry at the University of Alberta. Mr Oland was funded by the College of Physicians and Surgeons of Alberta.
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Address reprint requests to Brian H Rowe, MD, MSc, Division of Emergency Medicine, University of Alberta, Walter Mackenzie Centre, Room 1G1.63, 8440-112 Street Edmonton, Alberta, Canada T6G 2B7. E-mail: [email protected]
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