Garcia Isabel C, Clark Rachael A, Chung Dai H, Gaines Nakia
Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
Children (Basel). 2021 May 14;8(5):392. doi: 10.3390/children8050392.
Subcutaneous abscesses occur frequently in the pediatric population, yet there is great variability in the approach to diagnosis and management, partly due to opposing recommendations in the current literature and the lack of a standardized protocol for diagnosis and management among pediatric medical centers. This has led to inconsistencies by the providers, as well as the hospital clinical pathways, with regards to the appropriate management of subcutaneous abscesses. We hypothesize that the current variability in diagnostic work-up and management contributes to the wide use of unnecessary imaging and therapeutics without altering the overall outcomes. We performed a retrospective chart review that compared 200 encounters for patients < 18 years of age with a diagnosis of subcutaneous abscess at a single large tertiary pediatric institution. Our results showed that only 13.6% of wound cultures obtained led to a change in the antibiotic regimen and that blood cultures were positive in only 2.1% of cases. There was no difference in the incision and drainage performed based on ultrasound findings in the presence of fluctuance on physical exam. Patients presenting with fever were more likely to be admitted to the hospital for further care than those without fever. Our results showed no difference in outcome after incision and drainage for abscesses packed with gauze versus those left to drain via a vessel loop drain. There was no difference in recurrence in patients discharged with oral antibiotics versus without oral antibiotic treatment. Our data indicate that many of the diagnostic studies used for the management of a subcutaneous abscess have little to no effect on the outcome. Subcutaneous abscesses are a common pediatric complaint, and this study could help healthcare providers utilize more effective and efficient management strategies for skin and soft tissue infections.
皮下脓肿在儿科人群中频繁发生，但在诊断和治疗方法上存在很大差异，部分原因是当前文献中的建议相互矛盾，且儿科医疗中心缺乏标准化的诊断和治疗方案。这导致了医疗服务提供者以及医院临床路径在皮下脓肿的适当管理方面存在不一致。我们推测，目前诊断检查和治疗的差异导致了不必要的影像学检查和治疗方法的广泛使用，而这并未改变总体治疗结果。我们进行了一项回顾性病历审查，比较了一家大型三级儿科机构中200例年龄小于18岁、诊断为皮下脓肿的患者的就诊情况。我们的结果显示，仅13.6%的伤口培养结果导致了抗生素治疗方案的改变，血培养阳性率仅为2.1%。在体格检查发现波动的情况下，基于超声检查结果进行的切开引流并无差异。发热患者比无发热患者更有可能住院接受进一步治疗。我们的结果显示，用纱布填塞脓肿与通过血管环引流管引流的脓肿在切开引流后的治疗结果并无差异。出院时接受口服抗生素治疗的患者与未接受口服抗生素治疗的患者在复发率上没有差异。我们的数据表明，许多用于管理皮下脓肿的诊断研究对治疗结果几乎没有影响。皮下脓肿是儿科常见的病症，这项研究有助于医疗服务提供者对皮肤和软组织感染采用更有效、更高效的管理策略。
