Correlation of Physical Exam Findings with Fever in Patients with Skin and Soft Tissue Infections

Study Objectives The objectives of this study were to determine the prevalence of fever in adult ED patients with skin and soft tissue infections (SSTI) and to determine which, if any, physical exam, x-ray and laboratory test findings were associated with fever. Methods We conducted a prospective, observational study at an urban county trauma center of adults who presented to the ED for evaluation of suspected SSTI. ED providers measured area of erythema and induration using a tape measure, and completed data sheets indicating comorbid conditions and the presence or absence of physical exam findings. Fever was defined as any recorded temperature > 38°C during the first 6 hours of ED evaluation. Results Of the 734 patients enrolled, 96 (13.1%) had fever. Physical and laboratory exam findings associated with the presence of a fever in multivariable logistic regression were the area of erythema, particularly the largest quartile of area of erythema, 144 – 5000 cm2, (odd ratio (OR) = 2.9; 95% confidence interval [CI] = 1.6 – 5.2) and leukocytosis (OR = 4.4, 95% CI = 2.7 – 7.0). Bullae, necrosis, streaks, adenopathy, and bone involvement on imaging were not associated with fever. Conclusions Fever is uncommon in patients presenting to the ED for evaluation of suspected SSTI. Area of erythema and leukocytosis were associated with fever and should be considered in future decision rules for the evaluation and treatment of SSTI.