Abstract
IntroductionThe 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.MethodsWe 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.ResultsOf 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 cm2, (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.ConclusionFever 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.
Highlights
The objectives of this study were to determine the prevalence of fever in adult emergency department (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
Physical and laboratory exam findings associated with the presence of a fever in multivariable logistic regression were the area of erythema, the largest quartile of area of erythema, 144 – 5,000 cm[2], and leukocytosis (OR = 4.4, 95% confidence intervals (CI) [2.7 – 7.0])
Area of erythema and leukocytosis were associated with fever and should be considered in future decision rules for the evaluation and treatment of SSTI. [West J Emerg Med. 2017;18(3)398-402.]
Summary
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. Skin and soft tissue infections (SSTI), primarily cellulitis and abscesses, are increasingly common reasons for presentation to acute care facilities and admission to inpatient hospital facilities.[1,2,3] Despite this commonality of SSTI, very little evidence-based literature addresses the early evaluation of SSTI, and acute care diagnosis and treatment are largely driven by traditional teaching and convention. Guidelines acknowledge that the majority of SSTIs are not of significant severity but recommend further diagnostic evaluation in patients with signs and symptoms of systemic toxicity, including fever.[5] The febrile patient with cellulitis or an abscess is much more likely to be admitted to the hospital than the afebrile patient. It is standard practice to admit all injection drug users (IDUs) with fever and no clear source.[4,7]
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