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Am J Emerg Med. 2017 Feb;35(2):326-328. doi: 10.1016/j.ajem.2016.10.031. Epub 2016 Oct 17.

Factors influencing drainage setting and cost for cutaneous abscesses among pediatric patients.

Author information

1
Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Houston, TX. Electronic address: cechumpi@texaschildrens.org.
2
Department of Pediatrics, Baylor College of Medicine, Houston, TX. Electronic address: chris.rees@bcm.edu.
3
Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Houston, TX. Electronic address: eacamp@texaschildrens.org.
4
Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Houston, TX. Electronic address: karina3_7@hotmail.com.
5
Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Houston, TX. Electronic address: bc134109@bcm.edu.
6
Department of Pediatrics, Section of Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine, Houston, TX. Electronic address: chumpita@bcm.edu.
7
Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Houston, TX. Electronic address: fap@bcm.edu.

Abstract

OBJECTIVE:

To evaluate the clinical and microbiological factors associated with skin and soft tissue infections drained in the emergency department (ED) vs operative drainage (OD) in a tertiary care children's hospital.

METHODS:

This was a cross-sectional study among children aged 2 months to 17 years who required incision and drainage (I&D). Demographic information, signs and symptoms, abscess size and location, and wound culture/susceptibility were recorded. Patient-specific charges were collected from the billing database. Multivariate regression analysis was used to determine factors determining setting for I&D and the effect of abscess drainage location on cost.

RESULTS:

Of 335 abscesses, 241 (71.9%) were drained in the ED. OD for abscesses was favored in children with prior history of abscess (odds ratio [OR], 3.18; 95% confidence interval [CI], 1.36-7.44; P = .01) and labial location (OR, 37.81; 95% CI, 8.12-176.03; P < .001). For every 1-cm increase in size, there was approximately a 26% increase in the odds of having OD (OR, 1.26; 95% CI, 1.11-1.44, P < .001). Methicillin-resistant Staphylococcus aureus was identified in 72% of the 300 abscesses cultured and 12.3% were clindamycin resistant. OD was more expensive than I&D in the ED. Per abscess that underwent I&D, OD is $3804.29 more expensive than I&D in the ED while controlling for length of stay.

DISCUSSION:

Clinical factors associated with OD rather than I&D in the ED included history of abscess, increased abscess length, and labial location. Microbiological factors did not differ based on I&D setting. For smaller, nonlabial abscesses, ED drainage may result in significant cost savings.

PMID:
28029490
DOI:
10.1016/j.ajem.2016.10.031
[Indexed for MEDLINE]

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