Soft Tissue Abscess: Update Course 2015

At one institution, most abscesses are drained in the emergency department by ED physicians with sedation, with occasional surgical assistance.

At another institution, abscesses are routinely drained in the operating room rather than the emergency department.

Conscious sedation is needed for adequate abscess drainage; without it, families are unhappy and drainage is inadequate because children become scared and the procedure is rushed.

One surgeon uses vessel loops for abscess drainage and considers it a game changer compared to traditional packing.

Cellulitis is a criterion for admitting children after abscess drainage.

The combination of cellulitis, fever, and leukocytosis would prompt admission after abscess drainage.

Sick-appearing children should be admitted after abscess drainage to ensure clinical improvement before discharge.

At one institution, patients with cellulitis go home with antibiotics after abscess drainage; those without cellulitis receive no antibiotics.

In a retrospective review of children who underwent incision and drainage in the OR and were discharged the same day (typically 2-3 hours post-procedure), the treatment failure rate was 0.9%.

Treatment failure was defined as readmission or need for another incision and drainage within two weeks.

Among patients with leukocytosis, only 2 out of 138 (1.4%) had treatment failure after same-day discharge.

Only one patient who was febrile during hospitalization had a treatment failure after same-day discharge.

Some patients with white blood cell counts as high as 35,000 were discharged home and did well without admission.

The low failure rate in patients with marked leukocytosis raises the question of whether obtaining white blood cell counts is clinically useful.