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{ "pk": 17924, "title": "Management of Pediatric Skin Abscesses in Pediatric, General Academic and Community Emergency Departments", "subtitle": null, "abstract": "Objectives: To compare the evaluation and management of pediatric cutaneous abscess patients at three different emergency department (ED) settings.\n\n\nMethod: 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.\n\n\nResult: 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%).\n\n\nConclusion: 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.]", "language": "en", "license": { "name": "Creative Commons Attribution-NonCommercial 4.0", "short_name": "CC BY-NC 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNonCommercial — You may not use the material for commercial purposes.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by-nc/4.0" }, "keywords": [ { "word": "abscess" }, { "word": "pediatrics" }, { "word": "Emergency Medicine" }, { "word": "soft tissue infections" }, { "word": "methicillin-resistant Staphylococcus aureus" }, { "word": "Bacterial Infections and Mycoses" }, { "word": "Skin and Connective Tissue Diseases" } ], "section": "Pediatrics", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/7fq6r7x9", "frozenauthors": [ { "first_name": "Brigitte", "middle_name": "M.", "last_name": "Baumann", "name_suffix": "", "institution": "Department of Emergency Medicine, University of Medicine and Dentistry of New Jersey – Robert Wood Johnson Medical School at Camden, NJ", "department": "None" }, { "first_name": "Christopher", "middle_name": "J.", "last_name": "Russo", "name_suffix": "", "institution": "Division of Emergency Medicine, A.I. duPont Hospital for Children, Wilmington, DE", "department": "None" }, { "first_name": "Daniel", "middle_name": "", "last_name": "Pavlik", "name_suffix": "", "institution": "Department of Emergency Medicine, Our Lady of Lourdes Medical Center, Camden, NJ", "department": "None" }, { "first_name": "Tara", "middle_name": "N.", "last_name": "Cassidy-Smith", "name_suffix": "", "institution": "Department of Emergency Medicine, University of Medicine and Dentistry of New Jersey – Robert Wood Johnson Medical School at Camden, NJ", "department": "None" }, { "first_name": "Naomi", "middle_name": "", "last_name": "Brown", "name_suffix": "", "institution": "Division of Emergency Medicine Children’s Hospital of Philadelphia, PA", "department": "None" }, { "first_name": "Alfred", "middle_name": "", "last_name": "Sacchetti", "name_suffix": "", "institution": "Department of Emergency Medicine, Our Lady of Lourdes Medical Center, Camden, NJ", "department": "None" }, { "first_name": "Lisa", "middle_name": "M.", "last_name": "Capano-Wehrle", "name_suffix": "", "institution": "Department of Emergency Medicine, University of Medicine and Dentistry of New Jersey – Robert Wood Johnson Medical School at Camden, NJ", "department": "None" }, { "first_name": "Rakesh", "middle_name": "D.", "last_name": "Mistry", "name_suffix": "", "institution": "Division of Emergency Medicine Children’s Hospital of Philadelphia, PA", "department": "None" } ], "date_submitted": "2010-05-03T07:00:00Z", "date_accepted": "2010-05-03T07:00:00Z", "date_published": "2011-03-23T07:00:00Z", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/17924/galley/9147/download/" } ] }