ED management of cellulitis: A review of five urban centers

Cellulitis is a common problem presenting to the emergency department (ED). This study examines the epidemiology of cellulitis in 5 Canadian urban EDs and determines the practice variation in this management among sites. From computerized provincial ED diagnosis information, 10% of cellulitis charts from April 1, 1997 to March 31, 1998 were randomly selected for review. Al l 5 EDs in one urban region were sampled; physicians were unaware of the st udy when seeing patients. A standardized audit form was used to collect inf ormation pertaining to visits for the incident infection case. Cases were e xcluded if simple cellulitis was not the primary diagnosis or if procedures such as incision and drainage were initially required. A total of 416 adul t charts were retrospectively identified. The mean age was 46 years and 61% were men; 38% had seen another physician before the ED presentation. Cellu litis was most commonly located in the upper (41%) and lower (48%) extremit ies. Most! cases were treated with intravenous cefazolin (58%; range among sites: 49%-66%); however, over 25 different antibiotics and doses were init ially prescribed. Each case required a median of 4 (interquartile range [IQ R]: 1, 9) ED visits. Some patients (14%) received an increase in dose (3%) or a change in antibiotic regimen (11%) during their treatment. Few patient s (3%) required a second change in regimen. Specialist consultations were o btained in only 6% of patients and hospitalization was rare (7%). The most common discharge prescription was oral cephalexin (62%); however; many diff erent regimens were prescribed. Cellulitis is a common ED problem which con sumes considerable resources to treat. Considerable practice variation exis ts with respect to in-ED and post-ED management. These results suggest the need for the development of practice guidelines for the treatment of this c ommon ED problem. Copyright (C) 2001 by W.B. Saunders Company.