Accuracy of CREST Guideline in Management of Cellulitis in Emergency Department; a Systematic Review and Meta-analysis

Introduction: Skin and soft tissue infections are important causes of outpatient visits to medical clinics or hospitals. This study aimed to review the literature for the accuracy of Clinical Resource Efficiency Support Team (CREST) guideline in management of cellulitis in emergency department....

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Autores principales:	Hossein Akhavan, Seyed Reza Habibzadeh, Fatemeh Maleki, Mahdi Foroughian, Sayyed Reza Ahmadi, Reza Akhavan, Bita Abbasi, Behzad Shahi, navid kalani, Naser Hatami, Amir Mangouri, Sheida Jamalnia
Formato:	article
Lenguaje:	EN
Publicado:	Shahid Beheshti University of Medical Sciences 2021
Materias:	Cellulitis emergency service, hospital systematic review skin diseases bacterial anti-bacterial agents Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
Acceso en línea:	https://doaj.org/article/dae7ae0f4d104f0ea5010b71656aa008
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spelling	oai:doaj.org-article:dae7ae0f4d104f0ea5010b71656aa0082021-11-04T08:56:24ZAccuracy of CREST Guideline in Management of Cellulitis in Emergency Department; a Systematic Review and Meta-analysis10.22037/aaem.v9i1.14222645-4904https://doaj.org/article/dae7ae0f4d104f0ea5010b71656aa0082021-11-01T00:00:00Zhttps://journals.sbmu.ac.ir/aaem/index.php/AAEM/article/view/1422https://doaj.org/toc/2645-4904 Introduction: Skin and soft tissue infections are important causes of outpatient visits to medical clinics or hospitals. This study aimed to review the literature for the accuracy of Clinical Resource Efficiency Support Team (CREST) guideline in management of cellulitis in emergency department. Method: Studies that had evaluated cellulitis patients using the CREST guideline were quarried in Scopus, Web of Science, and PubMed database, from 2005 to the end of 2020. The quality of the studies was evaluated using Scottish Intercollegiate Guideline Network (SIGN) checklist for cohort studies. Pooled area under the receiver operating characteristic curve (AUROC) of CREST guideline regarding the rate of hospital stay more than 24 hours, rate of revisit, and appropriateness of antimicrobial treatment in management of cellulitis in emergency department was evaluated. Results: Seven studies evaluating a total of 1640 adult cellulitis patients were finally entered to the study. In evaluation of the rate of the appropriate treatment versus over-treatment, the pooled AUROC was estimated to be 0.38 (95% confidence interval (CI): 0.06 – 0.82), indicating low accuracy (AUROC lower than 0.5) of guideline for antimicrobial choice. CREST II patients had a significantly lower odds ratio (OR) of revisiting the Emergency Department, OR=0.21 (95% CI: 0.009‎ – ‎ 0.47). Pooled AUROC value of 0.86 (CI95%: 0.84 – 0.89) showed accuracy of the CREST classification in prediction of being hospitalized more or less than 24 hours. Conclusion: CREST classification shows good accuracy in determining the duration of hospitalization or observation in ED but it could lead to inevitable over/under treatment with empirical antimicrobial agents. Hossein AkhavanSeyed Reza HabibzadehFatemeh MalekiMahdi ForoughianSayyed Reza AhmadiReza AkhavanBita AbbasiBehzad Shahinavid kalaniNaser HatamiAmir MangouriSheida JamalniaShahid Beheshti University of Medical SciencesarticleCellulitisemergency service, hospitalsystematic reviewskin diseasesbacterialanti-bacterial agentsMedical emergencies. Critical care. Intensive care. First aidRC86-88.9ENArchives of Academic Emergency Medicine, Vol 9, Iss 1 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Cellulitis emergency service, hospital systematic review skin diseases bacterial anti-bacterial agents Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
spellingShingle	Cellulitis emergency service, hospital systematic review skin diseases bacterial anti-bacterial agents Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 Hossein Akhavan Seyed Reza Habibzadeh Fatemeh Maleki Mahdi Foroughian Sayyed Reza Ahmadi Reza Akhavan Bita Abbasi Behzad Shahi navid kalani Naser Hatami Amir Mangouri Sheida Jamalnia Accuracy of CREST Guideline in Management of Cellulitis in Emergency Department; a Systematic Review and Meta-analysis
description	Introduction: Skin and soft tissue infections are important causes of outpatient visits to medical clinics or hospitals. This study aimed to review the literature for the accuracy of Clinical Resource Efficiency Support Team (CREST) guideline in management of cellulitis in emergency department. Method: Studies that had evaluated cellulitis patients using the CREST guideline were quarried in Scopus, Web of Science, and PubMed database, from 2005 to the end of 2020. The quality of the studies was evaluated using Scottish Intercollegiate Guideline Network (SIGN) checklist for cohort studies. Pooled area under the receiver operating characteristic curve (AUROC) of CREST guideline regarding the rate of hospital stay more than 24 hours, rate of revisit, and appropriateness of antimicrobial treatment in management of cellulitis in emergency department was evaluated. Results: Seven studies evaluating a total of 1640 adult cellulitis patients were finally entered to the study. In evaluation of the rate of the appropriate treatment versus over-treatment, the pooled AUROC was estimated to be 0.38 (95% confidence interval (CI): 0.06 – 0.82), indicating low accuracy (AUROC lower than 0.5) of guideline for antimicrobial choice. CREST II patients had a significantly lower odds ratio (OR) of revisiting the Emergency Department, OR=0.21 (95% CI: 0.009‎ – ‎ 0.47). Pooled AUROC value of 0.86 (CI95%: 0.84 – 0.89) showed accuracy of the CREST classification in prediction of being hospitalized more or less than 24 hours. Conclusion: CREST classification shows good accuracy in determining the duration of hospitalization or observation in ED but it could lead to inevitable over/under treatment with empirical antimicrobial agents.
format	article
author	Hossein Akhavan Seyed Reza Habibzadeh Fatemeh Maleki Mahdi Foroughian Sayyed Reza Ahmadi Reza Akhavan Bita Abbasi Behzad Shahi navid kalani Naser Hatami Amir Mangouri Sheida Jamalnia
author_facet	Hossein Akhavan Seyed Reza Habibzadeh Fatemeh Maleki Mahdi Foroughian Sayyed Reza Ahmadi Reza Akhavan Bita Abbasi Behzad Shahi navid kalani Naser Hatami Amir Mangouri Sheida Jamalnia
author_sort	Hossein Akhavan
title	Accuracy of CREST Guideline in Management of Cellulitis in Emergency Department; a Systematic Review and Meta-analysis
title_short	Accuracy of CREST Guideline in Management of Cellulitis in Emergency Department; a Systematic Review and Meta-analysis
title_full	Accuracy of CREST Guideline in Management of Cellulitis in Emergency Department; a Systematic Review and Meta-analysis
title_fullStr	Accuracy of CREST Guideline in Management of Cellulitis in Emergency Department; a Systematic Review and Meta-analysis
title_full_unstemmed	Accuracy of CREST Guideline in Management of Cellulitis in Emergency Department; a Systematic Review and Meta-analysis
title_sort	accuracy of crest guideline in management of cellulitis in emergency department; a systematic review and meta-analysis
publisher	Shahid Beheshti University of Medical Sciences
publishDate	2021
url	https://doaj.org/article/dae7ae0f4d104f0ea5010b71656aa008
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Accuracy of CREST Guideline in Management of Cellulitis in Emergency Department; a Systematic Review and Meta-analysis

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