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

Area of Science:

• Pediatric Infectious Diseases
• Surgical Outcomes
• Healthcare Economics

Background:

• Skin and soft tissue infections requiring incision and drainage (I&D) are common in children.
• The optimal setting for I&D (emergency department vs. operative suite) has implications for clinical management and cost.

Purpose of the Study:

• To identify clinical and microbiological factors influencing the choice between emergency department (ED) drainage and operative drainage (OD) for pediatric abscesses.
• To assess the cost-effectiveness of ED drainage versus OD in a tertiary care children's hospital.

Main Methods:

• A cross-sectional study analyzed data from 335 children (2 months to 17 years) requiring abscess I&D.
• Data collected included demographics, abscess characteristics (size, location), clinical presentation, and wound cultures.
• Multivariate regression analyzed factors influencing drainage setting and cost implications.

Main Results:

• The majority of abscesses (71.9%) were drained in the ED.
• Factors favoring OD included a history of abscess, labial location, and larger abscess size (per 1-cm increase, 26% increased odds of OD).
• Methicillin-resistant Staphylococcus aureus (MRSA) was prevalent (72%), with 12.3% clindamycin resistance; microbiological factors did not differ by drainage setting.
• OD was significantly more expensive ($3804.29 per abscess) than ED drainage, controlling for length of stay.

Conclusions:

• Clinical factors like prior abscess history, increased size, and labial location predict the need for operative drainage.
• ED drainage is a cost-effective alternative for smaller, non-labial abscesses, offering substantial savings.
• Microbiological profiles of abscesses did not vary significantly between ED and operative drainage settings.