Journal Club
March 2010 Emergency Medicine Journal Club Vignette

You evaluate a 50 year old hypertensive female patient who comes in complaining of a red, warm rash to her abdomen. She has reported subjective fevers at home and states the area has increased in size over the last 2-3 days. She denies any trauma or injury. On exam, she has a temperature of 38 C, but otherwise her vital signs are stable. On her abdomen, she has an approximately 12 x 10 cm area of erythema, warmth, and tenderness over her mid abdomen. There is no appreciable induration or fluctuance on exam. She has a WBC of 12,000 with no bandemia. You correctly identify that she has an abdominal wall cellulitis and realize the need for antibiotic treatment. In light of the fever and size of the cellulitis, you feel she should be admitted to the hospital. However, the hospitalist on call suggests IV antibiotics in the CDU rather than admission. The patient looks well but the fever causes you some apprehension.

To investigate this, the following approach is explored:

PICO Question

Population: Adult patients with cellulitis
Intervention: Observation unit
Comparison: Admission to hospital
Outcome: <24 hours length of stay


Search Strategy: Pubmed; Keywords: cellulitis AND emergency department AND treatment. 162 citations found, of which the following three are selected after abstract review
First years: Predicting observation unit treatment failures in patients with skin and soft tissue infections. Int J Emerg Med 2008 1:85–90.

Article critique
Second years: Treatment failure in emergency department patients with cellulitis. CJEM 2005; 7(4):228-224.

Article critique
Third years: Soft tissue infections and emergency department disposition: predicting the need for inpatient admission. Acad Emerg Med. 2009 Dec;16(12):1290-7.

Article critique
1st & 2nd years use the "Prognosis Critical Review Form" (Download)
3rd years use the "Clinical Decision Rule Review Form" (Download)


Extra Articles: Management of patients with infectious diseases in an emergency department observation unit. Emerg Med Clin N America.
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