Emergency department disposition and hospital-based resource utilization for skin and soft tissue infections

Skin/soft tissue infections (SSTIs) are common emergency department (ED) presentations with substantial healthcare costs. When determining ED disposition, clinicians must balance risks of treatment failure against overusing hospitalization. Existing risk-stratification strategies target inpatient or outpatient subgroups and morbidity/mortality outcomes, leaving evidence gaps addressing the complete case mix and hospital-based resource utilization.

In this retrospective regional cohort of adult SSTI cases, the primary composite outcome captured hospital-based care requirements exceeding routine outpatient management across hospitalized (length of stay [LOS] >48 h, intensive care, operative intervention, discharge to non-residence, death) and discharged (72 h return with hospitalization) subjects. Logistic regression estimated associations between exposures and outcomes, including disposition-stratified subgroups.

Among 5567 subjects, 18.6% were hospitalized and 15.1% met the primary outcome (hospitalizations: 70.8%; discharges: 2.4%). In hospitalized subjects, LOS >48 h and discharge to non-residence were the most common events. Older age, diabetes (OR 1.65; 95% CI 1.37-1.98), chronic kidney disease (OR 1.34; 95% CI 1.08-1.68), lymphedema (OR 1.85; 95% CI 1.36-2.53), recent SSTI-related healthcare encounter (OR 1.64; 95% CI 1.35-1.99), and systemic inflammatory response syndrome (OR 4.43; 95% CI 3.59-5.47) were associated with higher odds of the primary outcome. Non-Hispanic Black race (OR 0.52; 95% CI 0.37-0.75), head/neck SSTI location (OR 0.67; 95% CI 0.46-0.98), and incision and drainage (OR 0.16; 95% CI 0.11-0.25) were associated with lower odds.

ED disposition largely aligned with subsequent clinical course. Discordance primarily reflected prolonged LOS rather than high-acuity events or early return visits with hospitalization. These findings support outpatient pathways for selected admissions and improved follow-up for higher-risk discharges.