Pediatric Subcutaneous Abscess: Still a Clinical Exam-Based Diagnosis and Treatment
Subcutaneous abscesses occur frequently in the pediatric population, yet there is great variability in the approach to diagnosis and management, partly due to opposing recommendations in the current literature and the lack of a standardized protocol for diagnosis and management among pediatric medic...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-05-01
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| Series: | Children |
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| Online Access: | https://www.mdpi.com/2227-9067/8/5/392 |
| _version_ | 1797534161165090816 |
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| author | Isabel C. Garcia Rachael A. Clark Dai H. Chung Nakia Gaines |
| author_facet | Isabel C. Garcia Rachael A. Clark Dai H. Chung Nakia Gaines |
| author_sort | Isabel C. Garcia |
| collection | DOAJ |
| description | Subcutaneous abscesses occur frequently in the pediatric population, yet there is great variability in the approach to diagnosis and management, partly due to opposing recommendations in the current literature and the lack of a standardized protocol for diagnosis and management among pediatric medical centers. This has led to inconsistencies by the providers, as well as the hospital clinical pathways, with regards to the appropriate management of subcutaneous abscesses. We hypothesize that the current variability in diagnostic work-up and management contributes to the wide use of unnecessary imaging and therapeutics without altering the overall outcomes. We performed a retrospective chart review that compared 200 encounters for patients < 18 years of age with a diagnosis of subcutaneous abscess at a single large tertiary pediatric institution. Our results showed that only 13.6% of wound cultures obtained led to a change in the antibiotic regimen and that blood cultures were positive in only 2.1% of cases. There was no difference in the incision and drainage performed based on ultrasound findings in the presence of fluctuance on physical exam. Patients presenting with fever were more likely to be admitted to the hospital for further care than those without fever. Our results showed no difference in outcome after incision and drainage for abscesses packed with gauze versus those left to drain via a vessel loop drain. There was no difference in recurrence in patients discharged with oral antibiotics versus without oral antibiotic treatment. Our data indicate that many of the diagnostic studies used for the management of a subcutaneous abscess have little to no effect on the outcome. Subcutaneous abscesses are a common pediatric complaint, and this study could help healthcare providers utilize more effective and efficient management strategies for skin and soft tissue infections. |
| first_indexed | 2024-03-10T11:25:40Z |
| format | Article |
| id | doaj.art-3f0ad998922c48bf97396db7ec1e96e0 |
| institution | Directory Open Access Journal |
| issn | 2227-9067 |
| language | English |
| last_indexed | 2024-03-10T11:25:40Z |
| publishDate | 2021-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Children |
| spelling | doaj.art-3f0ad998922c48bf97396db7ec1e96e02023-11-21T19:40:12ZengMDPI AGChildren2227-90672021-05-018539210.3390/children8050392Pediatric Subcutaneous Abscess: Still a Clinical Exam-Based Diagnosis and TreatmentIsabel C. Garcia0Rachael A. Clark1Dai H. Chung2Nakia Gaines3Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USADepartment of Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USADepartment of Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USADepartment of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USASubcutaneous abscesses occur frequently in the pediatric population, yet there is great variability in the approach to diagnosis and management, partly due to opposing recommendations in the current literature and the lack of a standardized protocol for diagnosis and management among pediatric medical centers. This has led to inconsistencies by the providers, as well as the hospital clinical pathways, with regards to the appropriate management of subcutaneous abscesses. We hypothesize that the current variability in diagnostic work-up and management contributes to the wide use of unnecessary imaging and therapeutics without altering the overall outcomes. We performed a retrospective chart review that compared 200 encounters for patients < 18 years of age with a diagnosis of subcutaneous abscess at a single large tertiary pediatric institution. Our results showed that only 13.6% of wound cultures obtained led to a change in the antibiotic regimen and that blood cultures were positive in only 2.1% of cases. There was no difference in the incision and drainage performed based on ultrasound findings in the presence of fluctuance on physical exam. Patients presenting with fever were more likely to be admitted to the hospital for further care than those without fever. Our results showed no difference in outcome after incision and drainage for abscesses packed with gauze versus those left to drain via a vessel loop drain. There was no difference in recurrence in patients discharged with oral antibiotics versus without oral antibiotic treatment. Our data indicate that many of the diagnostic studies used for the management of a subcutaneous abscess have little to no effect on the outcome. Subcutaneous abscesses are a common pediatric complaint, and this study could help healthcare providers utilize more effective and efficient management strategies for skin and soft tissue infections.https://www.mdpi.com/2227-9067/8/5/392subcutaneousabscessmanagement |
| spellingShingle | Isabel C. Garcia Rachael A. Clark Dai H. Chung Nakia Gaines Pediatric Subcutaneous Abscess: Still a Clinical Exam-Based Diagnosis and Treatment Children subcutaneous abscess management |
| title | Pediatric Subcutaneous Abscess: Still a Clinical Exam-Based Diagnosis and Treatment |
| title_full | Pediatric Subcutaneous Abscess: Still a Clinical Exam-Based Diagnosis and Treatment |
| title_fullStr | Pediatric Subcutaneous Abscess: Still a Clinical Exam-Based Diagnosis and Treatment |
| title_full_unstemmed | Pediatric Subcutaneous Abscess: Still a Clinical Exam-Based Diagnosis and Treatment |
| title_short | Pediatric Subcutaneous Abscess: Still a Clinical Exam-Based Diagnosis and Treatment |
| title_sort | pediatric subcutaneous abscess still a clinical exam based diagnosis and treatment |
| topic | subcutaneous abscess management |
| url | https://www.mdpi.com/2227-9067/8/5/392 |
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