Mongelluzzo Jillian, Tu Brian, Grimes Barbara, Ziyeh Sharvina, Fortman Jonathan, Neilson Jersey, Rodriguez Robert M
University of California, San Francisco, San Francisco General Hospital, Department of Emergency Medicine, San Francisco, California.
University of California, San Francisco, San Francisco, Department of Epidemiology and Biostatistics, San Francisco, California.
West J Emerg Med. 2017 Apr;18(3):398-402. doi: 10.5811/westjem.2016.12.32838. Epub 2017 Feb 27.
The objectives of this study were to determine the prevalence of fever in adult ED patients with skin and soft tissue infections (SSTI) and to determine which, if any, physical exam, radiograph and laboratory test findings were associated with fever.
We conducted a prospective, observational study at an urban county trauma center of adults who presented to the ED for evaluation of suspected SSTI. ED providers measured area of erythema and induration using a tape measure, and completed data sheets indicating comorbid conditions and the presence or absence of physical exam findings. Fever was defined as any recorded temperature ≥ 38°C during the first six hours of ED evaluation.
Of the 734 patients enrolled, 96 (13.1%) had fever. Physical and laboratory exam findings associated with the presence of a fever in multivariable logistic regression were the area of erythema, particularly the largest quartile of area of erythema, 144 - 5,000 cm, (odd ratio [OR] = 2.9; 95% confidence interval [CI] [1.6 - 5.2]) and leukocytosis (OR = 4.4, 95% CI [2.7 - 7.0]). Bullae, necrosis, streaks, adenopathy, and bone involvement on imaging were not associated with fever.
Fever is uncommon in patients presenting to the ED for evaluation of suspected SSTI. Area of erythema and leukocytosis were associated with fever and should be considered in future decision rules for the evaluation and treatment of SSTI.
本研究的目的是确定成年急诊科皮肤和软组织感染（SSTI）患者的发热患病率，并确定哪些体格检查、X线片和实验室检查结果（若有的话）与发热相关。
我们在一家城市县级创伤中心对因疑似SSTI到急诊科就诊的成年人进行了一项前瞻性观察研究。急诊科医护人员用卷尺测量红斑和硬结面积，并填写数据表，注明合并症以及体格检查结果的有无。发热定义为在急诊科评估的前6小时内记录到的任何体温≥38°C。
在纳入的734例患者中，96例（13.1%）有发热。多变量逻辑回归分析中与发热相关的体格检查和实验室检查结果是红斑面积，尤其是红斑面积最大的四分位数，144 - 5000平方厘米（比值比[OR]=2.9；95%置信区间[CI][1.6 - 5.2]）和白细胞增多（OR = 4.4，95% CI [2.7 - 7.0]）。影像学上的大疱、坏死、条纹、腺病和骨受累与发热无关。
因疑似SSTI到急诊科就诊的患者中发热并不常见。红斑面积和白细胞增多与发热相关，在未来SSTI评估和治疗的决策规则中应予以考虑。
