Soft Tissue Abscess: Update Course 2015

Space: StayCurrentMD Published: 2019-01-11

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Timestops

Introduction to Abscess Management

Discussion on the management of abscesses, focusing on incision and drainage procedures in the emergency department versus the operating room, including considerations for sedation and patient comfort.

Cost Analysis of Abscess Treatment

Exploration of cost implications of performing abscess drainage in the ED versus the OR, emphasizing potential savings and resource allocation.

Criteria for Hospital Admission

Criteria for admitting pediatric patients post-abscess drainage, focusing on signs of cellulitis, fever, and leukocytosis.

Antibiotic Management Post-Drainage

Discussion on the use of antibiotics after abscess drainage, including when to prescribe and when to send patients home without them.

Review of Treatment Outcomes

Presentation of retrospective data on treatment failures following incision and drainage, highlighting low rates of readmission and complications.

Conclusion and Future Directions

Summary of key findings and implications for clinical practice in managing pediatric abscesses, with a focus on improving patient outcomes and cost efficiency.

Topic overview

During the 3rd Annual Stay Current in Pediatric Surgery Update Course in 2015, Dr. Nicholas Bruns leads the discussion on management of soft tissue abscess. Topics discussed include management in the emergency room versus operating room, conscious sedation versus anesthesia, packing versus wick versus vessel loop, need for admission after drainage, and post-procedural antibiotics.

Intended audience: Healthcare professionals and clinicians.

Categories

Specialty

Anesthesiology General Surgery Pediatric Surgery

Anatomy/Organ System

Skin and Soft Tissue

Care Context

Emergency Operating Room

Population

Pediatric

Topic Format

Updates Work-up and Treatment

Clinical Task

Management

Keywords

abscess incision and drainage emergency department sedation cost savings cellulitis intravenous antibiotics leukocytosis treatment failure readmission febrile retrospective review pediatric care outpatient procedure patient management clinical guidelines infection control wound packing vessel loop

Hashtags

#AbscessManagement #IncisionAndDrainage #EmergencyMedicine #PediatricInfection #Sedation #CostEffectiveness #Cellulitis #IntravenousAntibiotics #Leukocytosis #TreatmentFailure #ReadmissionRates #ClinicalGuidelines #WoundCare #PediatricEmergency #InfectionControl #PatientSafety #OutpatientCare #HealthcareCosts #ClinicalOutcomes #EmergencyDepartment

Transcript

So to the hottest topic, abscess. So for the, uh, the standard butt abscess, uh, in your hospital, where do you do an incision and drainage in the ED in the butt. In the in the OR, where do you do it in the butt where do you do it? Um, we're just many more often than not, many of these are drained in the emergency by the ER or by frequently by the ED if not combination than a combination, but with sedation, with sedation, most are drained in the ED by ED with sedation, our help occasionally. That would put us out of business. We, we, um, we, uh, have, I think you found a substantial reduction in, or we didn't think. Did you find a reduction in cost between we, we haven't looked at that. We wanted to look at that. Because we do them in the OR and my guess is it's a big cost savings to do these, yeah, but you do need some conscious sedation, otherwise it's just families are right, pretty unhappy and they don't drain well, right? They get scared. They go real quick and they don't pack it or who packed, who are you getting into that? Does anyone pack or use vessel loop or nothing? Pack, pack, use a wick, yeah, wick, just something in there vessel loop if I'm if I'm at that level, it's a vessel loop. That's, it's changed game changer for me. Oh, I see, because most of them are drained by the ED. So there was that study at ABSA that showed that didn't make a difference, yet none of us follow it. OK, OK. And um, is there any criteria that makes you admit these kids to the hospital for intravenous antibiotics after, after they're drained? Yes, cellulitis. Yeah, I think if they have cellulitis, fever, and leukocytosis, I would admit that kid. All of those together or any of those? Some combination. Some, yeah, if the child's sick, I would admit them because you don't want them to get sicker. You want to make sure they're getting better before you, uh, cut them loose. So you reported your literature, right? Yeah, we'll, we'll get to that. Oh sorry. Uh, one last question, um, do you, do your patients go home with antibiotics? If they have cellulitis. If not, send him home with nothing. OK, great. So we looked at our own data and um did a retrospective review of all the kids that we did incision and drainage. So in the OR and then sent home the same day, usually about 2 or 3 hours after the procedure. And the rate of treatment failure, which we defined as readmission or needing another I&D within two weeks was minimal, so 0.9% of all patients had a treatment failure, and of the patients that had leukocytosis, only 2 out of 138 did, and only one that was febrile during their time in the hospital had a treatment failure as well. So, you know, there are some patients with white counts of 35 that got sent home and did fine, um, which would make me almost not want to know what the white count is. But um They are cost cutting on the antibiotics and. Spending more money on the OR. That's how we like to do things. All right, are you done, Nick? Yep, good job. All right, reading. All right, Ian Glenn.

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