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Journal of General Internal Medicine

, Volume 33, Issue 9, pp 1553–1560 | Cite as

Do Patients with Cellulitis Need to be Hospitalized? A Systematic Review and Meta-analysis of Mortality Rates of Inpatients with Cellulitis

  • Craig G. Gunderson
  • Benjamin M. Cherry
  • Ann Fisher
Review Paper

Abstract

Background

Cellulitis is a common cause of hospitalization. In the USA, the International Classification of Diseases (ICD) code “other cellulitis and abscess” accounts for 1.4% of all admissions and $5.5 billion in annual costs. The Infectious Disease Society of America recommends hospitalization for patients with cellulitis under certain circumstances but there is little actual clinical evidence to guide the decision to admit. The purpose of this study is to determine the mortality rate of patients hospitalized with cellulitis and to ascertain if the rate is comparable to the rate for low risk patients with community acquired pneumonia that are currently recommended for outpatient management.

Methods

A systematic literature search was conducted for studies of consecutive patients hospitalized with cellulitis or erysipelas that reported inpatient mortality. Study quality was assessed using a modified Newcastle-Ottawa Quality Assessment Scale. The mortality rates from the included studies were pooled using a random effects model. Heterogeneity was estimated using the I2 statistic.

Results

Eighteen studies met inclusion criteria. The overall worldwide mortality rate was 1.1% (95% confidence interval (CI), 0.7–1.8). For studies from the USA, the rate was 0.5% (95% CI 0.3–0.9). The actual cause of death was generally poorly described, and only one third of deaths appeared to be due to infection.

Discussion

The estimated mortality rate for patients currently being hospitalized for cellulitis is comparable to the mortality rate of patients with community-acquired pneumonia that are recommended for outpatient management by the Pneumonia Severity Index and CURB65 prediction models and strongly endorsed by major infectious disease societies. Outpatient management of these patients could result in large cost savings and may be much preferred by patients.

KEY WORDS

Cellulitis Mortality Epidemiology Hospitalization 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors have no conflicts to disclose.

Supplementary material

11606_2018_4546_MOESM1_ESM.docx (14 kb)
ESM 1 (DOCX 13.9 kb)

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Copyright information

© Society of General Internal Medicine 2018

Authors and Affiliations

  • Craig G. Gunderson
    • 1
    • 2
  • Benjamin M. Cherry
    • 1
    • 2
  • Ann Fisher
    • 2
    • 3
  1. 1.Department of Internal Medicine, Section of General Internal Medicine Yale University School of MedicineWest HavenUSA
  2. 2.Veterans Affairs Connecticut Healthcare SystemWest HavenUSA
  3. 3.Department of Internal Medicine, Section of Infectious DiseasesYale University School of MedicineNew HavenUSA

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