title: Factors influencing drainage setting and cost for cutaneous abscesses among pediatric patients.
abstract: OBJECTIVE
  To evaluate the clinical and microbiological factors associated with skin and soft tissue infections drained in the emergency department (ED) vs operative drainage (OD) in a tertiary care children's hospital.
  
  
  METHODS
  This was a cross-sectional study among children aged 2 months to 17 years who required incision and drainage (I&D). Demographic information, signs and symptoms, abscess size and location, and wound culture/susceptibility were recorded. Patient-specific charges were collected from the billing database. Multivariate regression analysis was used to determine factors determining setting for I&D and the effect of abscess drainage location on cost.
  
  
  RESULTS
  Of 335 abscesses, 241 (71.9%) were drained in the ED. OD for abscesses was favored in children with prior history of abscess (odds ratio [OR], 3.18; 95% confidence interval [CI], 1.36-7.44; P = .01) and labial location (OR, 37.81; 95% CI, 8.12-176.03; P < .001). For every 1-cm increase in size, there was approximately a 26% increase in the odds of having OD (OR, 1.26; 95% CI, 1.11-1.44, P < .001). Methicillin-resistant Staphylococcus aureus was identified in 72% of the 300 abscesses cultured and 12.3% were clindamycin resistant. OD was more expensive than I&D in the ED. Per abscess that underwent I&D, OD is $3804.29 more expensive than I&D in the ED while controlling for length of stay.
  
  
  CONCLUSIONS
  Clinical factors associated with OD rather than I&D in the ED included history of abscess, increased abscess length, and labial location. Microbiological factors did not differ based on I&D setting. For smaller, nonlabial abscesses, ED drainage may result in significant cost savings.
authors.affiliation: Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Houston, TX. Electronic address: cechumpi@texaschildrens.org.
authors.forename: Corrie E
authors.initials: CE
authors.lastname: Chumpitazi
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Houston, TX. Electronic address: chris.rees@bcm.edu.
authors.forename: Chris A
authors.initials: CA
authors.lastname: Rees
authors.affiliation: Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Houston, TX. Electronic address: eacamp@texaschildrens.org.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Camp
authors.affiliation: Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Houston, TX. Electronic address: karina3_7@hotmail.com.
authors.forename: Karina L
authors.initials: KL
authors.lastname: Valdez
authors.affiliation: Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Houston, TX. Electronic address: bc134109@bcm.edu.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Choi
authors.affiliation: Department of Pediatrics, Section of Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine, Houston, TX. Electronic address: chumpita@bcm.edu.
authors.forename: Bruno P
authors.initials: BP
authors.lastname: Chumpitazi
authors.affiliation: Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Houston, TX. Electronic address: fap@bcm.edu.
authors.forename: Faria
authors.initials: F
authors.lastname: Pereira
mesh_terms: D000038:Abscess / Q000191:economics / Q000601:surgery*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D003430:Cross-Sectional Studies; D062109:Dermatologic Surgical Procedures / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006776:Hospitals, Pediatric / Q000191:economics / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D015999:Multivariate Analysis; D000070316:Pediatric Emergency Medicine / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012874:Skin Diseases, Infectious / Q000191:economics / Q000601:surgery*; D018461:Soft Tissue Infections / Q000191:economics / Q000601:surgery*; D013203:Staphylococcal Infections / Q000191:economics / Q000601:surgery*; D018709:Statistics, Nonparametric; D013396:Suction / Q000191:economics / Q000379:methods