Background: Skin and soft tissue infection (SSTI) is one of the most common diagnoses at San Francisco General Hospital (SFGH). Large incisions under general anesthesia are common in the inpatient setting to rule-out necrotizing soft tissue infection (NSTI). In the community setting and in the ED, SSTIs are treated under local anesthesia with small incisions. Most cases of NSTI present with symptoms indicative of a rapidly progressing process. To determine if the practice of aggressive treatment for routine SSTIs to rule out NSTI is justified, we conducted a comprehensive chart review of all cases of NSTI at SFGH to determine if cases of NSTI were missed prior to admission.
Methods: Between 1996-2000, all cases of NSTI and SSTI by ICD-9 seen at SFGH were identified. Evidence of any medical care 31 days prior to the admission for NSTI was collected.
Results: There were 13782 visits for SSTI leading to 7084 (51%) admissions. There were 139 (2.0%) documented cases of NSTI. 45/139 (32%) were seen by a provider in the 31 days prior to admission. None had surgical treatment for an SSTI prior to admission while 4/140 had been treated medically for an SSTI that may have developed into an NSTI.
Conclusion: There is no evidence that cases of NSTI were missed surgically prior to admission. Less aggressive treatment for non-complicated SSTIs should be the standard of care. Aggressive care should be limited to cases that clinically present as NSTI. This change in practice could significantly reduce the costs of treatment for SSTI.
Learning Objectives: Learn to distinguish between skin and soft-tissue infections which require aggressive treatment from those that require medical treatment or simple incision & drainage
Keywords: Substance Abuse, Injection Drug Users
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.