From the Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University (AS, MAB, OJM, CDN), Portland, OR; and the Southwest Washington Medical Center (BJ), Vancouver, WA.
Acad Emerg Med. 2009 Dec;16(12):1290-1297. doi: 10.1111/j.1553-2712.2009.00536.x.
Little empiric evidence exists to guide emergency department (ED) disposition of patients presenting with soft tissue infections. This study's objective was to generate a clinical decision rule to predict the need for greater than 24-hour hospital admission for patients presenting to the ED with soft tissue infection.
This was a retrospective cohort study of consecutive patients presenting to a tertiary care hospital ED with diagnosis of nonfacial soft tissue infection. Standardized chart review was used to collect 29 clinical variables. The primary outcome was >24-hour hospital admission (either general admission or ED observation unit), regardless of initial disposition. Patients initially discharged home and later admitted for more than 24 hours were included in the outcome. Data were analyzed using classification and regression tree (CART) analysis and multivariable logistic regression.
A total of 846 patients presented to the ED with nonfacial soft tissue infection. After merging duplicate records, 674 patients remained, of which 81 (12%) required longer than 24-hour admission. Using CART, the strongest predictors of >24-hour admission were patient temperature at ED presentation and mechanism of infection. In the multivariable logistic regression model, initial patient temperature (odds ratio [OR] for each degree over 37 degrees C = 2.91, 95% confidence interval [CI] = 1.65 to 5.12) and history of fever (OR = 3.02, 95% CI = 1.41 to 6.43) remained the strongest predictors of hospital admission. Despite these findings, there was no combination of factors that reliably identified more than 90% of target patients.
Although we were unable to generate a high-sensitivity decision rule to identify ED patients with soft tissue infection requiring >24-hour admission, the presence of a fever (either by initial ED vital signs or by history) was the strongest predictor of need for >24-hour hospital stay. These findings may help guide disposition of patients presenting to the ED with nonfacial soft tissue infections.
目前针对急诊科（ED）就诊的软组织感染患者，指导其处置的经验证据有限。本研究旨在建立一种临床决策规则，以预测 ED 就诊的软组织感染患者需要住院 24 小时以上的可能性。
这是一项连续就诊于三级医疗中心 ED 的非面部软组织感染患者的回顾性队列研究。采用标准化病历回顾收集了 29 个临床变量。主要结局是 24 小时以上的住院（包括普通病房或 ED 观察病房），无论初始处置如何。最初出院后因超过 24 小时而再次入院的患者也被纳入结局。采用分类和回归树（CART）分析和多变量逻辑回归分析数据。
共有 846 例 ED 就诊的非面部软组织感染患者。合并重复记录后，剩余 674 例患者，其中 81 例（12%）需要住院超过 24 小时。采用 CART，24 小时以上住院的最强预测因素是 ED 就诊时的患者体温和感染机制。在多变量逻辑回归模型中，初始患者体温（每升高 1 摄氏度的优势比[OR]为 2.91，95%置信区间[CI]为 1.65 至 5.12）和发热史（OR = 3.02，95%CI = 1.41 至 6.43）仍然是住院的最强预测因素。尽管存在这些发现，但没有任何因素组合能够可靠地识别超过 90%的目标患者。
尽管我们无法生成一种高灵敏度的决策规则来识别需要 24 小时以上住院的 ED 软组织感染患者，但发热（无论是初始 ED 生命体征还是病史）是需要 24 小时以上住院的最强预测因素。这些发现可能有助于指导 ED 就诊的非面部软组织感染患者的处置。
