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

Abstract

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 (χ2 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.