NURSES ROLE IN CELLULITIS CASES TO REDUCE FALL-RELATED HOSPITALIZATION

Purpose: Evaluate associations between falls and anatomical location of cellulitis for Emergency Department (ED) patients. Background: Falls are a major cause of injury and affected adults and children strongly impact nursing practice. For example, the combined domestic direct-care and lost-productivity costs of falls exceeds $81 billion annually. Also, while cellulitis rates affect relatively few, ~24/1000 person-years Americans annually, over 9 million office and emergency department (ED) visits are attributable to cellulitis, costing >$98 million annually.  Nurses evaluate and treat patients with cellulitis in a variety of settings.  However, nurses do not see patients with cellulitis at an increased risk for falls.  Fall-related hospitalizations may be reduced if new preventable causes are identified, such as cellulitis.  Ultimately, nursing research can identify causes that lead to effective nursing practice interventions that will reduce costs and resource utilization and improve the public's health.  Methods: Cross-sectional population-based analysis of the Nationwide Emergency Department Sample (NEDS) dataset; a weighted random sample of U.S. hospital-based emergency department visits, linked to hospitalization records, yielding national and regional rates. Exposure of interests, upper extremity ([UE], ICD-9 682.0-682.4) and lower extremity ([LE], ICD-9 682.8-682.9) cellulitis were identified from ICD-9 coded ED diagnoses. Outcome of interest, hospitalization rates (/100,000) was estimated using weighted, tabular age-specific stratified analyses.  Results: Together hospitalization and lower extremity cellulitis rates increased with age: e.g., 237/100,000 18-44 year olds were evaluated in EDs for fall-related injuries while 712 cases of LE cellulitis (/100,000) adults ≥85 year olds were similarly evaluated. Among people that presented to the ED with a fall as an external cause of injury, LE cellulitis increased risk for hospitalization across all age groups, when compared to those without cellulitis (Rate Ratio [RR]=1.78-5.57, p-values£0.05). Fallers with both LE and UE cellulitis showed higher hospitalization rates than unaffected infants, children, and adults (RR=2.17-8.24, p-values<0.05). Fallers with only UE cellulitis were less likely to be hospitalized than unaffected comparators younger than 65 years (RR= 0.40-0.94, p-values £0.05); however, those older than 65 were no more likely than those without UE cellulitis (RR=1.19, p>0.05). Implications: Developing early intervention strategies to prevent falls resulting in major injury is important; LE cellulitis may physiologically alter sensorium and balance in ways that lead to falls.  These analyses show LE cellulitis more commonly affect older age groups and increase rates of hospitalization among those who fall. Although fallers with UE cellulitis <65 years of age are less likely to be hospitalized, findings may relate to differences in fall characteristics and comorbid conditions.  Questions for future nursing research include explicating causal risk factors for LE cellulitis associated falls, especially those that result in hospitalization.  Injury-reduction strategies may be informed by early screening and treatment strategies targeted at LE cellulitis are integral to nursing practice.