Introduction: National guidelines suggest that most skin abscesses do not require antibiotics, and that cellulitis antibiotics should target streptococci, not community-associated MRSA (CA-MRSA). The objective of this study is to describe antimicrobial treatment of skin infections in U.S. emergency departments (EDs) and analyze potential quality measures.

Methods: The National Hospital Ambulatory Medical Care Survey (NHAMCS) is a 4-stage probability sample of all non-federal U.S. ED visits. In 2007 NHAMCS started recording whether incision and drainage was performed at ED visits. We conducted a retrospective analysis, pooling 2007-2010 data, identified skin infections using diagnostic codes, and identified abscesses by performance of incision and drainage. We generated national estimates and 95% confidence intervals using weighted analyses; quantified frequencies and proportions; and evaluated antibiotic prescribing practices. We evaluated 4 parameters that might serve as quality measures of antibiotic stewardship, and present 2 of them as potentially robust enough for implementation.

Results: Of all ED visits, 3.2% (95% confidence interval 3.1-3.4%) were for skin infection, and 2.7% (2.6-2.9%) were first visits for skin infection, with no increase over time (p=0.80). However, anti-CA-MRSA antibiotic use increased, from 61% (56-66%) to 74% (71-78%) of antibiotic regimens (p<0.001). Twenty-two percent of visits were for abscess, with a non-significant increase (p=0.06). Potential quality measures: Among discharged abscess patients, 87% were prescribed antibiotics (84-90%, overuse). Among antibiotic regimens for abscess patients, 84% included anti-CA-MRSA agents (81-89%, underuse).

Conclusion: From 2007-2010, use of anti-CA-MRSA agents for skin infections increased significantly, despite stable visit frequencies. Antibiotics were over-used for discharged abscess cases, and CA-MRSA-active antibiotics were underused among regimens when antibiotics were used for abscess. [West J Emerg Med. 2014;15(3):282–289.]

Introduction: Nothing has been published to describe the practices of medical societies in choosing abstracts for presentations at their annual meetings. We surveyed medical societies to determine their practices, and also present a theoretical analysis of the topic.

Methods: We contacted a convenience sample of large U.S. medical conferences, and determined their approach to choosing abstracts. We obtained information from web sites, telephone, and email. Our theoretical analysis compares values-based and empirical approaches for scoring system development.

Results: We contacted 32 societies and obtained data on 28 (response rate 88%). We excluded one upon learning that research was not presented at its annual meeting, leaving 27 for analysis. Only 2 (7%) made their abstract scoring process available to submitters. Reviews were blinded in most societies (21; 78%), and all but one asked reviewers to recuse themselves for conflict of interest (96%). All required ≥3 reviewers. Of the 24 providing information on how scores were generated, 21 (88%) reported using a single gestalt score, and three used a combined score created from pooled domain-specific sub-scores. We present a framework for societies to use in choosing abstracts, and demonstrate its application in the development of a new scoring system.

Conclusions: Most medical societies use subjective, gestalt methods to select research for presentation at their annual meetings and do not disclose to submitters the details of how abstracts are chosen. We present a new scoring system that is transparent to submitters and reviewers alike with an accompanying statement of values and ground rules. We discuss the challenges faced in selecting abstracts for a large scientific meeting and share the values and practical considerations that undergird the new system.

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Introduction: Our goal was to develop and validate an index to predict in-hospital mortality in olderadults after non-traumatic emergency department (ED) intubations.

Methods: We used Vizient administrative data from hospitalizations of 22,374 adults >75 years whounderwent non-traumatic ED intubation from 2008-2015 at nearly 300 U.S. hospitals to develop andvalidate an index to predict in-hospital mortality. We randomly selected one half of participants for thedevelopment cohort and one half for the validation cohort. Considering 25 potential predictors, wedeveloped a multivariable logistic regression model using least absolute shrinkage and selection operatormethod to determine factors associated with in-hospital mortality. We calculated risk scores using pointsderived from the final model’s beta coefficients. To evaluate calibration and discrimination of the finalmodel, we used Hosmer-Lemeshow chi-square test and receiver-operating characteristic analysis andcompared mortality by risk groups in the development and validation cohorts.

Results: Death during the index hospitalization occurred in 40% of cases. The final model included sixvariables: history of myocardial infarction, history of cerebrovascular disease, history of metastatic cancer,age, admission diagnosis of sepsis, and admission diagnosis of stroke/ intracranial hemorrhage. Thosewith low-risk scores (<6) had 31% risk of in-hospital mortality while those with high-risk scores (>10) had58% risk of in-hospital mortality. The Hosmer-Lemeshow chi-square of the model was 6.47 (p=0.09), andthe c-statistic was 0.62 in the validation cohort.

Conclusion: The model may be useful in identifying older adults at high risk of death after ED intubation.