Mistry Rakesh D, Hirsch Alexander W, Woodford Ashley L, Lundy Megan
Department of Pediatrics, Section of Emergency Medicine, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado.
Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts.
J Emerg Med. 2015 Dec;49(6):855-63. doi: 10.1016/j.jemermed.2015.02.007. Epub 2015 Apr 30.
The effectiveness of observation unit (OU) management of skin and soft tissue infections (SSTI) has not been fully evaluated.
This study was performed to determine the rate and risk factors.
Retrospective cohort study of children ages 2 months to 18 years admitted to the OU for an SSTI between 2007 and 2010 from a pediatric emergency department (ED). Failure of OU therapy was defined as subsequent inpatient ward admission, re-admission after discharge from OU, initial or repeat incision and drainage after OU admission, or change in antibiotic therapy. Demographic, clinical, and lesion characteristics were collected. Comparative analyses were conducted to determine factors associated with OU failure; prolonged OU admission, defined as length of stay ≥ 36 h was evaluated.
One hundred ninety-two (63.2%) of 304 subjects with SSTI were eligible; mean age was 6.2 ± 5.3 years, and 52% were male. Fever (≥38°C) in the ED was present for 77 (40%). Most lesions were skin abscesses (53%) and were located on the lower extremity (36%) and buttock/genitourinary (21%). OU treatment failure occurred in 22% (95% confidence interval [CI] 16.5-28.3), primarily due to inpatient admission. Fever on ED presentation was significantly associated with OU failure (odds ratio 2.02; 95% CI 1.02-4.02). Demographics, body site, presence of abscess, and methicillin-resistant Staphylococcus aureus were not associated with OU failure. Prolonged OU admission occurred in 18 subjects (9.4%).
SSTI can be successfully treated in the OU, though febrile children with SSTI are at risk for OU treatment failure and should be considered for inpatient admission.
观察单元（OU）管理皮肤和软组织感染（SSTI）的有效性尚未得到充分评估。
本研究旨在确定其发生率及危险因素。
对2007年至2010年期间因SSTI从儿科急诊科收治入OU的2个月至18岁儿童进行回顾性队列研究。OU治疗失败定义为随后入住住院病房、OU出院后再次入院、OU入院后初次或重复切开引流，或抗生素治疗改变。收集人口统计学、临床和病变特征。进行比较分析以确定与OU治疗失败相关的因素；评估住院时间延长（定义为住院时间≥36小时）情况。
304例SSTI患者中有192例（63.2%）符合条件；平均年龄为6.2±5.3岁，52%为男性。急诊科有77例（40%）出现发热（≥38°C）。大多数病变为皮肤脓肿（53%），位于下肢（36%）和臀部/泌尿生殖系统（21%）。OU治疗失败发生率为22%（95%置信区间[CI]16.5 - 28.3），主要原因是住院治疗。急诊科就诊时发热与OU治疗失败显著相关（优势比2.02；95%CI 1.02 - 4.02）。人口统计学、身体部位、脓肿存在情况和耐甲氧西林金黄色葡萄球菌与OU治疗失败无关。18例（9.4%）患者住院时间延长。
SSTI可在OU中成功治疗，不过发热的SSTI儿童有OU治疗失败的风险，应考虑住院治疗。
