Burden, risk factors, and infectious complications of cellulitis and erysipelas in US adults and children in the emergency department setting

Abstract

Background: Little is known about the use and burden of emergency department (ED) visits for cellulitis/erysipelas in the United States.

Objective: To determine the prevalence, risk factors, complications, and cost of emergency care for cellulitis/erysipelas in the United States.

Methods: Cross-sectional study of the 2006 to 2016 National Emergency Department Sample, including a 20% sample of US ED visits (N = 320,080,467).

Results: The mean annual incidence of ED visits with a primary diagnosis of cellulitis/erysipelas was 2.42 to 3.55 per million adult and 1.14 to 2.09 per million pediatric ED visits. ED visits for cellulitis/erysipelas decreased significantly from 2006 to 2015 (Rao-Scott chi-square, P < .0001). ED visits with versus without a primary diagnosis of cellulitis/erysipelas were associated with public or no insurance and lower household income quartiles, and were more likely to occur during weekends and summer months. The mean cost of ED visits for cellulitis/erysipelas more than doubled in adults (from $720 to $1680) and tripled in children (from $939 to $2,823) from 2006 to 2016. ED visits for cellulitis/erysipelas were associated with multiple risk factors and increased infectious complications.

Limitations: No data on cellulitis and erysipelas treatment or recurrence.

Conclusion: There is a substantial and increasing burden of ED visits for cellulitis/erysipelas in the United States. Many ED visits occurred for uncomplicated cellulitis/erysipelas, in part because of health care disparities.

Keywords: autoimmune; bacteria; burden; dermatology; epidemiology; health services; infection; inflammatory; skin.