Management of Pediatric Skin Abscesses in Pediatric, General Academic and Community Emergency Departments
Objectives: To compare the evaluation and management of pediatric cutaneous abscess patients at three different emergency department (ED) settings.Method: We conducted a retrospective cohort study at two academic pediatric hospital EDs, a general academic ED and a community ED in 2007, with random s...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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eScholarship Publishing, University of California
2011-05-01
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| Series: | Western Journal of Emergency Medicine |
| Subjects: | |
| Online Access: | http://escholarship.org/uc/item/7fq6r7x9 |
| _version_ | 1811235224571346944 |
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| author | Baumann, Brigitte M Russo, Christopher J Pavlik, Daniel Cassidy-Smith, Tara N Brown, Naomi Sacchetti, Alfred |
| author_facet | Baumann, Brigitte M Russo, Christopher J Pavlik, Daniel Cassidy-Smith, Tara N Brown, Naomi Sacchetti, Alfred |
| author_sort | Baumann, Brigitte M |
| collection | DOAJ |
| description | Objectives: To compare the evaluation and management of pediatric cutaneous abscess patients at three different emergency department (ED) settings.Method: We conducted a retrospective cohort study at two academic pediatric hospital EDs, a general academic ED and a community ED in 2007, with random sampling of 100 patients at the three academic EDs and inclusion of 92 patients from the community ED. Eligible patients were ≤18 years who had a cutaneous abscess. We recorded demographics, predisposing conditions, physical exam findings, incision and drainage procedures, therapeutics and final disposition. Laboratory data were reviewed for culture results and antimicrobial sensitivities. For subjects managed as outpatients from the ED, we determined where patients were instructed to follow up and, using electronic medical records, ascertained the proportion of patients who returned to the ED for further management.Result: Of 392 subjects, 59% were female and the median age was 7.7 years. Children at academic sites had larger abscesses compared to community patients, (3.5 versus 2.5 cm, p=0.02). Abscess incision and drainage occurred in 225 (57%) children, with the lowest rate at the academic pediatric hospital EDs (51%) despite the relatively larger abscess size. Procedural sedation and the collection of wound cultures were more frequent at the academic pediatric hospital and the general academic EDs. Methicillin-resistant Staphylococcus aureus (MRSA) prevalence did not differ among sites; however, practitioners at the academic pediatric hospital EDs (92%) and the general academic ED (86%) were more likely to initiate empiric MRSA antibiotic therapy than the community site (71%), (p<0.0001). At discharge, children who received care at the community ED were more likely to be given a prescription for a narcotic (23%) and told to return to the ED for ongoing wound care (65%). Of all sites, the community ED also had the highest percentage of follow-up visits (37%).Conclusion: Abscess management varied among the three settings, with more conservative antibiotic selection and greater implementation of procedural sedation at academic centers and higher prescription rates for narcotics, self-referrals for ongoing care and patient follow-up visits at the community ED. [West J Emerg Med. 2011;12(2):159-167.] |
| first_indexed | 2024-04-12T11:47:31Z |
| format | Article |
| id | doaj.art-9ac67e1b7e9a4918be27fb67122c0c1a |
| institution | Directory Open Access Journal |
| issn | 1936-900X 1936-9018 |
| language | English |
| last_indexed | 2024-04-12T11:47:31Z |
| publishDate | 2011-05-01 |
| publisher | eScholarship Publishing, University of California |
| record_format | Article |
| series | Western Journal of Emergency Medicine |
| spelling | doaj.art-9ac67e1b7e9a4918be27fb67122c0c1a2022-12-22T03:34:17ZengeScholarship Publishing, University of CaliforniaWestern Journal of Emergency Medicine1936-900X1936-90182011-05-01122159167Management of Pediatric Skin Abscesses in Pediatric, General Academic and Community Emergency DepartmentsBaumann, Brigitte MRusso, Christopher JPavlik, DanielCassidy-Smith, Tara NBrown, NaomiSacchetti, AlfredObjectives: To compare the evaluation and management of pediatric cutaneous abscess patients at three different emergency department (ED) settings.Method: We conducted a retrospective cohort study at two academic pediatric hospital EDs, a general academic ED and a community ED in 2007, with random sampling of 100 patients at the three academic EDs and inclusion of 92 patients from the community ED. Eligible patients were ≤18 years who had a cutaneous abscess. We recorded demographics, predisposing conditions, physical exam findings, incision and drainage procedures, therapeutics and final disposition. Laboratory data were reviewed for culture results and antimicrobial sensitivities. For subjects managed as outpatients from the ED, we determined where patients were instructed to follow up and, using electronic medical records, ascertained the proportion of patients who returned to the ED for further management.Result: Of 392 subjects, 59% were female and the median age was 7.7 years. Children at academic sites had larger abscesses compared to community patients, (3.5 versus 2.5 cm, p=0.02). Abscess incision and drainage occurred in 225 (57%) children, with the lowest rate at the academic pediatric hospital EDs (51%) despite the relatively larger abscess size. Procedural sedation and the collection of wound cultures were more frequent at the academic pediatric hospital and the general academic EDs. Methicillin-resistant Staphylococcus aureus (MRSA) prevalence did not differ among sites; however, practitioners at the academic pediatric hospital EDs (92%) and the general academic ED (86%) were more likely to initiate empiric MRSA antibiotic therapy than the community site (71%), (p<0.0001). At discharge, children who received care at the community ED were more likely to be given a prescription for a narcotic (23%) and told to return to the ED for ongoing wound care (65%). Of all sites, the community ED also had the highest percentage of follow-up visits (37%).Conclusion: Abscess management varied among the three settings, with more conservative antibiotic selection and greater implementation of procedural sedation at academic centers and higher prescription rates for narcotics, self-referrals for ongoing care and patient follow-up visits at the community ED. [West J Emerg Med. 2011;12(2):159-167.]http://escholarship.org/uc/item/7fq6r7x9abscesspediatricsemergency medicinesoft tissue infectionsMethicillin-Resistant Staphylococcus aureus |
| spellingShingle | Baumann, Brigitte M Russo, Christopher J Pavlik, Daniel Cassidy-Smith, Tara N Brown, Naomi Sacchetti, Alfred Management of Pediatric Skin Abscesses in Pediatric, General Academic and Community Emergency Departments Western Journal of Emergency Medicine abscess pediatrics emergency medicine soft tissue infections Methicillin-Resistant Staphylococcus aureus |
| title | Management of Pediatric Skin Abscesses in Pediatric, General Academic and Community Emergency Departments |
| title_full | Management of Pediatric Skin Abscesses in Pediatric, General Academic and Community Emergency Departments |
| title_fullStr | Management of Pediatric Skin Abscesses in Pediatric, General Academic and Community Emergency Departments |
| title_full_unstemmed | Management of Pediatric Skin Abscesses in Pediatric, General Academic and Community Emergency Departments |
| title_short | Management of Pediatric Skin Abscesses in Pediatric, General Academic and Community Emergency Departments |
| title_sort | management of pediatric skin abscesses in pediatric general academic and community emergency departments |
| topic | abscess pediatrics emergency medicine soft tissue infections Methicillin-Resistant Staphylococcus aureus |
| url | http://escholarship.org/uc/item/7fq6r7x9 |
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