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Photodocumentation as an emergency department documentation tool in soft tissue infection: a randomized trial

Published online by Cambridge University Press:  04 March 2015

Adam Lund ,
Daniel Joo ,
Kerrie Lewis ,
Yasemin Arikan  and
Anton Grunfeld
Adam Lund
Affiliation:
Department of Emergency Medicine, University of British Columbia, Vancouver, BC
Daniel Joo*
Affiliation:
Department of Emergency Medicine, University of British Columbia, Vancouver, BC
Kerrie Lewis
Affiliation:
Department of Emergency Medicine, University of British Columbia, Vancouver, BC
Yasemin Arikan
Affiliation:
Department of Internal Medicine, Division of Infectious Diseases, University of British Columbia, Vancouver, BC
Anton Grunfeld
Affiliation:
Department of Emergency Medicine, University of British Columbia, Vancouver, BC
*
Emergency Department, Lions Gate Hospital, 231 E 15th Street, North Vancouver, BC V7L 2L7; [email protected]

Abstract:

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Objectives:

Current documentation methods for patients with skin and soft tissue infections receiving outpatient parenteral anti-infective therapy (OPAT) include written descriptions and drawings of the infection that may inadequately communicate clinical status. We undertook a study to determine whether photodocumentation (PD) improves the duration of outpatient treatment of skin and soft tissue infections.

Methods:

A single-blinded, prospective, randomized trial was conducted in the emergency departments of a community hospital and an academic tertiary centre. Participants included consecutive patients age ≥ 14 years presenting with noninvasive skin and soft tissue infections requiring OPAT. Patients in the intervention arm were treated with standard of care plus PD at each emergency physician assessment. Control subjects received care provided at the discretion of the treating physician and non-photographic documentation. The primary outcome was duration of therapy measured in half-days. The required sample size to detect a difference of one half-day was 253 patients per group (α = 0.05). Secondary outcomes included (1) completion and therapeutic failure rates, (2) patient satisfaction, and (3) physician and nurse satisfaction.

Results:

Enrolment was slower and follow-up rates lower than anticipated, and the trial was terminated when funds were exhausted. A total of 468 subjects with similar age and gender characteristics were enrolled, with 244 receiving the intervention and 224 in the control arm. The mean OPAT duration was similar in the two groups (3.6 days v. 3.5 days, p = 0.73). No differences in the rate for completion and therapeutic failure were observed (71% v. 68% and < 1% for both, respectively). Survey response rates varied significantly: patients, 65%; nurses, 17%; and physicians, 87%. Physicians endorsed more comfort with their assessment and OPAT judgment with PD (65% and 64%, respectively). Physicians cited too much time lost with technological challenges, which would affect implementation in a busy ED.

Conclusions:

PD as an intervention is acceptable to patients and has reasonable endorsement by the majority of physicians. This trial had significant limitations that threatened the integrity of the study, so the results are inconclusive.

Keywords

hospital emergency serviceintravenous injectionphotographyrandomized controlled trialsoft tissue infections
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 15 , Issue 6 , November 2013 , pp. 345 - 352
Copyright
Copyright © Canadian Association of Emergency Physicians 2013

References

REFERENCES

1. Wai, AO, Frighetto, L, Marra, CA, et al. Cost analysis of an adult outpatient parenteral antibiotic therapy (OPAT) programme. A Canadian teaching hospital and Ministry of Health perspective. Pharmacoeconomics 2000;18:451–7, doi:10.2165/00019053-200018050-00004.Google Scholar
2. Deery, HG. Outpatient parenteral anti-infective therapy for skin and soft-tissue infections. Infect Dis Clin North Am 1998;12:935–49, doi:10.1016/S0891-5520(05)70029-5.CrossRefGoogle ScholarPubMed
3. Yong, C, Fisher, DA, Sklar, GE, et al. A cost analysis of outpatient parenteral antibiotic therapy (OPAT): an Asian perspective. Int J Antimicrob Agents 2009;33:46–51, doi:10.1016/j.ijantimicag.2008.07.016.Google Scholar
4. Williams, DN, Rehm, AD, Tice, AD, et al. Practice guidelines for community-based parenteral anti-infective therapy. Clin Infect Dis 1997;25:787–801, doi:10.1086/515552.Google Scholar
5. Tice, AD, Rehm, SJ, Daloviso, JR, et al. Practice guidelines for outpatient parenteral antimicrobial therapy. Clin Infect Dis 2004;38:1651–72, doi:10.1086/420939.CrossRefGoogle ScholarPubMed
6. Abrahamian, FM, Talan, DA, Moran, GJ. Management of skin and soft-tissue infections in the emergency department. Infect Dis Clin North Am 2008;22:89–116, doi:10.1016/j.idc.2007.12.001.CrossRefGoogle ScholarPubMed
7. Eisenstein, BI. Treatment challenges in the management of complicated skin and soft-tissue infections. Clin Microbiol Infect 2008;14 Suppl 2:17–25.Google Scholar
8. Brook, I. Microbiology and management of soft tissue and muscle infections. Int J Surg 2008;6:328–38, doi:10.1016/j.ijsu.2007.07.001.Google Scholar
9. Stevens, DL, Eron, LL. Cellulitis and soft-tissue infections. Ann Intern Med 2009;150:ITC11.Google Scholar
10. Stevens, DL, Bisno, AL, Chamgers, HF, et al. Practice guidelines for the diagnosis and management of skin and soft-tissue infections. Clin Infect Dis 2005;41:1373–406, doi:10.1086/497143.Google Scholar
11. Phoenix, G, Das, S, Joshi, M. Diagnosis and management of cellulitis. BMJ 2012;345:e955.Google Scholar
12. Eron, LJ, Lipsky, BA, Low, DE, et al. Managing skin and soft tissue infections: expert panel recommendations on key decision points. J Antimicrob Chemother 2003;52 Suppl S1:i3–17, doi:10.1093/jac/dkg466.Google Scholar
13. Clinical Resource Efficiency Support Team (2005). Guidelines on the management of cellulitis in adults. Available at: http://www.acutemed.co.uk/docs/cellulitis%20guidelines,%20CREST,%2005.pdf (accessed February 2013).Google Scholar
14. Brem, H, Kirsner, RS, Falanga, V. Protocol for the successful treatment of venous ulcers. Am J Surg 2004;188(1 Suppl 1): 1S-8S, doi:10.1016/S0002-9610(03)00299-X.Google Scholar
15. Brem, H, Sheehan, P, Rosenberg, HJ, et al. Evidence-based protocol for diabetic foot ulcers. Plast Reconstr Surg 2006;117(7 Suppl):193S–209S.Google Scholar
16. Gupta, M, Berk, DR, Gray, C, et al. Morphologic features and natural history of scalp nevi in children. Arch Dermatol 2010;146:506–11, doi:10.1001/archdermatol.2010.88.Google Scholar
17. Rennert, R, Golinko, M, Kaplan, D, et al. Standardization of wound photography using the wound electronic medical record. Adv Skin Wound Care 2009;22:32–8, doi:10.1097/01.ASW.0000343718.30567.cb.Google Scholar
18. Ahkee, S, Smith, S, Newman, D. Early switch from intravenous to oral antibiotics in hospitalized patients with infections: a 6-month prospective study. Pharmacotherapy 1997;17:569–75.CrossRefGoogle ScholarPubMed
19. Cox, NH, Colver, GB, Paterson, WD. Management and morbidity of cellulitis of the leg. J R Soc Med 1998;91:634–7.CrossRefGoogle ScholarPubMed
20. Eron, LJ. The admission, discharge and oral switch decision processes in patients with skin and soft tissue infections. Curr Treat Options Infect Dis 2003;5:245–50.Google Scholar
21. Brown, G, Chamberlain, R, Goulding, J, et al. Ceftriaxone versus cefazolin with probenecid for severe skin and soft tissue infections. J Emerg Med 1996;14:547–51, doi:10.1016/S0736-4679(96)00126-6.Google Scholar
22. Corwin, P, Toop, L, McGeoch, G, et al. Randomised controlled trial of intravenous antibiotic treatment for cellulitis at home compared with hospital. BMJ 2005;330:129, doi:10.1136/bmj.38309.447975.EB.CrossRefGoogle ScholarPubMed
23. Grayson, ML, McDonald, M, Gibson, K, et al. Once-daily intravenous cefazolin plus oral probenecid is equivalent to once-daily intravenous ceftriaxone plus oral placebo for the treatment of moderate-to-severe cellulitis in adults. Clin Infect Dis 2002;34:1440–8, doi:10.1086/340056.Google Scholar
24. Lund, A. Digital photography IVT. Available at: http://www.rchemerg.com/Academics/Academic-Projects-at-ERH-and-RCH/Digital-Photography-IVT (accessed June 7, 2013).Google Scholar
25. Burns, K, Duffett, M, Kho, ME, et al. A guide for the design and conduct of self-administered surveys of clinicians. Can Med Assoc J 2008;179:245–52, doi:10.1503/cmaj.080372.Google Scholar