The management of cellulitis and erysipelas at an academic emergency department: current practice versus the literature
Bibliographic record
Abstract
Cellulitis and erysipelas are common presentations to emergency departments and family physicians. Evidence-based guidelines for appropriate management of these infections exist in Canada, but inconsistent practices persist. Our objective was to determine the level of adherence to current evidence and guidelines by emergency physicians at the two hospitals in Kingston, Ontario, Canada. We identified all of the electronic medical records of patients who were seen at Kingston General Hospital or Hotel Dieu Hospital between January 1, 2015 and June 30, 2015 and given a diagnosis of cellulitis or erysipelas. We randomly selected 182 charts and conducted a retrospective chart review, manually collecting data for patient demographics, medical history, and medical management. Oral cephalexin alone was given to 44% of our sample, and it was the most common form of therapy for uncomplicated cellulitis. 36% of patients given any antibiotics at all received at least one dose of parenteral antibiotics, despite only 6.7% of these patients showing systemic signs of illness. 88% of those receiving parenteral antibiotics received ceftriaxone, a broad-spectrum, third generation cephalosporin. We found wide variation in antibiotic selection and route of administration for patients presenting to the emergency department with cellulitis or erysipelas. Overuse of antibiotics is common, and we believe the use of parenteral antibiotics may have been unnecessary for some patients in our sample. Emergency physicians should align their management plans more closely with the current guidelines to improve practice and reduce unnecessary administration of broad-spectrum parenteral antibiotics.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.037 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.003 | 0.006 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".