TABLE 1.
Olecranon bursitis patient and ED management based on ED bursal aspiration and ED disposition
| Characteristic | Patients, No. (%) a | |||||
|---|---|---|---|---|---|---|
| ED bursal aspiration (n = 4) | Admitted (n = 39) | Dismissed with antibiotics (n = 147) | Dismissed without antibiotics (n = 76) | All patients (N = 266) | p value e | |
| Age (years), median (IQR) | 45 (39–52) | 54 (42–61) | 58 (45–70) | 59 (47–69) | 57 (42–69) | 0.583 |
| Sex | 0.041 | |||||
| Female | 0 (0) | 11 (28) | 21 (14) | 7 (9) | 39 (14.6) | |
| Male | 4 (100) | 28 (72) | 126 (86) | 69 (91) | 227 (85.3) | |
| Race | 0.503 | |||||
| White | 4 (100) | 35 (90) | 138 (94) | 69 (91) | 246 (92.8) | |
| Black | 0 (0) | 3 (8) | 3 (2) | 1 (1) | 7 (2.6) | |
| Asian | 0 (0) | 0 (0) | 1 (1) | 1 (1) | 2 (0.7) | |
| Other | 0 (0) | 1 (3) | 5 (3) | 5 (7) | 11 (4.1) | |
| ED presentation | ||||||
| Reported fever | 2 (50) | 9 (23) | 17 (12) | 0 (0) | 28 (10.4) | <0.001 |
| Fever in ED | 0 (0) | 2 (5) | 2 (1) | 0 (0) | 4 (1.5) | 0.144 |
| Erythema | 4 (100) | 39 (100) | 133 (91) | 28 (37) | 204 (77.0) | <0.001 |
| Cellulitis | 0 (0) | 17 (44) | 36 (24) | 4 (5) | 57 (21.4) | <0.001 |
| Warmth | 3 (75) | 30 (77) | 97 (66) | 19 (25) | 149 (56.0) | <0.001 |
| Swelling | 4 (100) | 37 (95) | 142 (97) | 67 (88) | 250 (94.0) | 0.070 |
| Abrasion/wound | 1 (25) | 9 (23) | 49 (33) | 7 (9) | 66 (24.8) | <0.001 |
| Tenderness | 3 (75) | 28 (72) | 100 (68) | 32 (42) | 163 (61.3) | 0.002 |
| Pain | 4 (100) | 36 (92) | 126 (86) | 59 (78) | 225 (84.6) | 0.159 |
| Comorbid conditions | ||||||
| Steroids | 1 (25) | 5 (13) | 22 (15) | 11 (14) | 39 (14.6) | 0.677 |
| HIV | 0 (0) | 0 (0) | 1 (1) | 0 (0) | 1 (0.4) | >0.99 |
| Gout | 0 (0) | 4 (10) | 9 (6) | 9 (12) | 22 (8.2) | 0.420 |
| Arthritis | 0 (0) | 2 (5) | 2 (1) | 0 (0) | 4 (1.5) | 0.136 |
| History of MRSA | 0 (0) | 2 (5) | 4 (3) | 1 (1) | 7 (2.6) | 0.474 |
| Diabetes | 0 (0) | 7 (18) | 17 (12) | 13 (17) | 37 (13.8) | 0.502 |
| Other immunocompromised | 0 (0) | 3 (8) | 2 (1) | 1 (1) | 6 (2.2) | 0.172 |
| Imaging/laboratory values | ||||||
| Radiograph | 2 (50) | 31 (80) | 88 (60) | 40 (53) | 161 (60.5) | 0.030 |
| Ultrasound | 2 (50) | 2 (5) | 10 (7) | 1 (1) | 15 (5.6) | 0.007 |
| WBCs b (cells/mm3) |
10 (9–11) [N = 2] |
10 (7–12) [N = 38] |
10 (8–12) [N = 70] |
9 (8–10) [N = 13] |
10 (8–12) [N = 123] |
0.739 |
| CRP b (µg/dL) |
— [N = 0] |
50 (22–89) [N = 36] |
32 (14–50) [N = 53] |
11 (5–61) [N = 8] |
36 (14–62) [N = 97] |
0.006 |
| ESR b (mm/h) |
— [N = 0] |
19 (10–41) [N = 32] |
11 (6–24) [N = 52] |
12 (7–41) [N = 7] |
14 (7–31) [N = 91] |
0.112 |
| ED orthopedic consult | 0 (0) | 29 (74) | 36 (25) | 4 (5) | 69 (25.9) | <0.001 |
| Antibiotics prescribed at dismissal | 4 (100) | 32 (82) | 147 (100) | 0 (0) | 183 (68.8) | — |
| Cephalosporin (first/second generation) | 0 (0) | 10 (26) | 75 (51) | 0 (0) | 85 (32.0) | — |
| Cephalosporin (third generation) | 0 (0) | 4 (10) | 1 (1) | 0 (0) | 5 (1.9) | — |
| Penicillin | 2 (50) | 1 (3) | 21 (14) | 0 (0) | 23 (8.6) | — |
| Clindamycin | 1 (25) | 0 (0) | 11 (7) | 0 (0) | 12 (4.5) | — |
| Trimethoprim/sulfamethoxazole | 1 (25) | 5 (13) | 11 (7) | 0 (0) | 17 (6.4) | — |
| IV vancomycin | 0 (0) | 3 (8) | 2 (1) | 0 (0) | 5 (1.9) | — |
| Doxycycline | 0 (0) | 3 (8) | 6 (4) | 0 (0) | 9 (3.3) | — |
| Other | 0 (0) | 2 (5) c | 4 (3) d | 0 (0) | 7 (2.6) | — |
| Cephalosporin + trimethoprim/sulfamethoxazole | 0 (0) | 2 (5) | 10 (7) | 0 (0) | 12 (4.5) | — |
| Cephalosporin + doxycycline | 0 (0) | 1 (3) | 2 (1) | 0 (0) | 3 (1.1) | — |
| Penicillin + trimethoprim/sulfamethoxazole | 0 (0) | 1 (3) | 3 (2) | 0 (0) | 4 (1.5) | — |
| Penicillin + doxycycline | 0 (0) | 0 (0) | 1 (1) | 0 (0) | 1 (0.4) | — |
| Inpatient antibiotics | ||||||
| Cephalosporin (first/second generation) | 0 (0) | 1 (3) | 0 (0) | 0 (0) | 1 (0.4) | — |
| Trimethoprim/sulfamethoxazole | 0 (0) | 1 (3) | 0 (0) | 0 (0) | 1 (0.4) | — |
| Doxycycline | 0 (0) | 1 (3) | 0 (0) | 0 (0) | 1 (0.4) | — |
| IV cefazolin | 0 (0) | 6 (15) | 0 (0) | 0 (0) | 6 (2.3) | — |
| IV trimethoprim/sulfamethoxazole | 0 (0) | 1 (3) | 0 (0) | 0 (0) | 1 (0.4) | — |
| IV vancomycin | 0 (0) | 15 (38) | 0 (0) | 0 (0) | 15 (5.6) | — |
| Cephazolin + vancomycin | 0 (0) | 4 (10) | 0 (0) | 0 (0) | 4 (1.5) | — |
| Ceftriaxone + vancomycin | 0 (0) | 3 (8) | 0 (0) | 0 (0) | 3 (1.1) | — |
| Vancomycin + other | 0 (0) | 5 (13) | 0 (0) | 0 (0) | 5 (1.9) | — |
| Lost to follow‐up | 1 (25) | 1 (3) | 13 (9) | 9 (12) | 24 (9.0) | 0.174 |
| At least 6 months of follow‐up | 3 (75) | 34 (87) | 122 (83) | 61 (80) | 220 (82.7) | 0.792 |
| At least 3 months of follow‐up | 3 (75) | 34 (87) | 128 (87) | 64 (84) | 229 (86.1) | 0.851 |
Data are reported as n (%) unless otherwise specified. SI conversion factors: To convert WBC to 109/L multiply by 1. To convert CRP to mg/L multiply by 10.
Abbreviations: CRP, C‐reactive protein; ESR, erythrocyte sedimentation rate; HIV, human immunodeficiency virus; IQR, interquartile range; MRSA, methicillin‐resistant Staphylococcus aureus; WBC, white blood cell count.
Unless otherwise noted.
Medians and IQRs are given only for patients with available data, indicated for each entry.
Both patients were dismissed on IV daptomycin.
Two of the four patients were dismissed with MRSA coverage (one IV daptomycin, one minocycline).
p‐values are from comparisons between the four disposition groups given in the table using Kruskal‐Wallis tests for continuous features and chi‐square or Fisher's exact tests for categorical features.