Incidence and factors associated with emergency department visits for recurrent skin and soft tissue infections in patients in California, 2005-2011

摘要

More than 2 million visits for skin and soft tissue infections (SSTIs) are seen in US emergency departments (EDs) yearly. Up to 50 of patients with SSTIs, suffer from recurrences, but associated factors remain poorly understood. We performed a retrospective study of patients with primary diagnosis of SSTI between 2005 and 2011 using California ED discharge data from the State Emergency Department Databases and State Inpatient Databases. Using a multivariable logistic regression, we examined factors associated with a repeat SSTI ED visits up to 6 months after the initial SSTI. Among 197 371 SSTIs, 16.3 were associated with a recurrent ED visit. We found no trend in recurrent visits over time (x(2) trend = 0.68, P = 0.4). Race/ ethnicity, age, geographical location, household income, and comorbidities were all associated with recurrent visits. Recurrent ED visits were associated with drug/ alcohol abuse or liver disease odds ratio (OR) 1.4, 95 confidence interval (CI) 1.3- 1.4, obesity ( OR 1.3, 95 CI 1.2- 1.4), and in infections that were drained (OR 1 . 1, 95 CI 1.1- 1.1) and inversely associated with hospitalization after initial ED visit (OR 0.4, 95 CI 0.3- 0.4). In conclusion, we found several patient- level factors associated with recurrent ED visits. Identification of these high- risk groups is critical for future ED-based interventions.