Sajitha Nair, is a General Medicine Advance Trainee at the Royal Brisbane and Women's Hospital. She has a special interest in Rhuematology and is looking forward to do dual training in Gen medicine and Rheumatology.
Clinical Assessment For Potential Ambulatory Management Of Cellulitis Patients Presenting To The Emergency Department
To identify suitability for ambulatory management of cellulitis patients admitted from the emergency department (ED) of the Royal Brisbane & Women’s Hospital, and to identify potential factors evident at triage that may predict the course of inpatient admission.
164 patients with cellulitis as their principal diagnosis were studied in this retrospective audit. Potential suitability for ambulatory management was determined by application of the previously validated Ambulatory management score (AMB), National Early Warning Score (NEWS) and Charlson Comorbidity Index (CCI) and their statistical correlation with length of stay (LOS), duration of intravenous antibiotics (IVABs), coded complications including illness or readmission.
Results and discussions:
The LOS was significantly higher among patients with NEWS of ≥ 3 and with AMB <5. The median LOS in patients with NEWS < 3 was 0.81 and NEWS ≥3 was 1.25 (P value 0.0025). 76 patients had AMB ≥ 5. The median LOS in patients with AMB score <5 was 0.9 and AMB ≥ 5 was 0.72 (P value 0.0027)
The median duration of IVABs in patients with NEWS <3 and NEWS ≥3 were both 2 days with a P value of 0.033.
Patients with higher CCI neither required longer duration of IVABs nor had increased LOS. Comparing LOS in patients with and without complications /readmissions, no statistically significant difference was found.
The study identified clinical findings that may prognosticate LOS for those patients who are deemed to require inpatient admission. Implementing NEWS and AMB scoring in the ED may help estimate inpatient LOS. Provision of ambulatory care to a broader cohort of patients may be possible, for patients with an AMB score >5. Prospective study on above parameters in appropriate disposition and management of cellulitis in ED is envisaged.