Introduction: Cellulitis is a common dermatological soft tissue infection presenting to Australian Emergency Departments (ED). Hospital in the Home (HITH) is a useful care model to support home-based intravenous antibiotics for its treatment. Several risk factors worsen the morbidity of cellulitis including tinea pedis, previous cellulitis, intravenous drug usage, diabetes mellitus, and immunosuppression.1 We aimed to identify the risk factors that lead to an increased incidence of hospital re-presentations for patients admitted to HITH with lower limb cellulitis from an emergency setting.
Methods: We conducted a retrospective case-control chart review of adult Emergency Department (ED) presentations with an ICD-10 diagnosis of lower limb cellulitis (L03.115-6) admitted to HITH from Monash Health Emergency Departments between 01 January 2020 and 31 December 2021. The presence of relevant risk factors of cellulitis were identified from clinical documentation. Re-presentations were defined as an unplanned return to ED for worsening lower limb cellulitis within 2 weeks of admission to HITH.
Results: A total of 11 patients re-presented to hospital for worsening lower limb cellulitis after being admitted to HITH compared to 154 controls who did not re-present. Previous episodes of cellulitis (OR=10.2447, 95% CI: 2.1311 to 49.2486, p = 0.0037) and type 1 diabetes mellitus (OR=44.1429, 95% CI: 1.6927 to 1151.2063, p = 0.0228) were associated with a re-presentation from HITH. No association was observed between all other studied risk factors.
Conclusion: A history of previous cellulitis and type 1 diabetes mellitus significantly increased the odds of a re-presentation after HITH admission. Inpatient admission should be considered in patients with this history to minimise healthcare cost related to re-presentation. Prudent history taking for associated risk factors is vital to making decisions to direct the care pathway within ED and improve holistic patient care.