Date of Award

2020-05-23

Degree Name

PhD Nursing

Dissertation Committee

Cynthia D. Connelly, PhD, RN, FAAN, Chairperson; K. Sue Hoyt, PhD, RN, FNP-BC, ENP-C, FAEN, FAANP, FAAN, Committee Member; Karen Macauley, PhD, DNP, FNP-BC, GNP-BC, Committee Member

Keywords

emergency, abscess, cellulitis, skin and soft tissue infections

Abstract

Background/Purpose: Skin and soft tissue infections (SSTI) represent a diverse group of infections varying in clinical presentation and degree of severity. The International Classification of Diseases codes for patients presenting with cellulitis or abscess account for $5.5 billion in annual health care costs and 1.4% of all hospital admissions nationally. Data are needed to inform admission and management decisions. The purpose of this study is to examine relationships among sociodemographic, physical examination findings, and treatment modality and management in patients with SSTIs.

Theoretical/Conceptual Framework: Web of Causation Theoretical Framework explores multiple causative factors treated with equal prominence, thus facilitating a non- linear evaluative approach for an understanding of the etiology and patient specific characteristics as influential factors to any process disease and its management.

Method: Retrospective, cohort design. Data were extracted from the electronic health records of a convenience sample (N = 857), aged 18 and older diagnosed with an upper or lower extremity SSTI, receiving Emergency Department services at a high-volume Southern California rural ED, January 1, 2016 through December 31, 2018. Descriptive and inferential analyses.

Results: Average age 45.65 + 17.17 years, 67.1% male, 75% Hispanic origin. Final diagnosis: 56.9% cellulitis, 40.1% abscess, 2.2% both cellulitis and abscess, 0.7% other SSTI; 97.7% discharged home; 2.3% admitted; 8.8% returned within 24 hours of discharge. Age was significantly different for patients’ final diagnosis, Welch's F(3, 20) = 24.30, p < .001; younger age for abscess (M = 40.69, SD = 13.61) compared to cellulitis (M = 49.60, SD = 18.55); abscess and cellulitis (M = 35.00, SD = 11.00) compared to cellulitis (M = 49.60, SD = 18.55) and final disposition F(1, 855) = 6.78, p = .009; older age significantly increased for those admitted to the hospital (M = 55.50, SD = 13.95) compared to discharged home (M = 45.42, SD = 17.17).

Conclusions and Implications: Age and heart rate should be included when evaluating and treating a patient with SSTIs. Study findings within this rural community support the consideration and incorporation of sociodemographic factors and social determinents of health as central for standardized care within all communities.

Document Type

Dissertation: Open Access

Department

Nursing

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