Pediatric emergency care · 2025
Discrepancies Between Estimated and Expressed Abscess Volume in Pediatric Incision and Drainage.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
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Neal Jeffrey T, Waltman Elizabeth M, Miller Andrew F, Gravel Cynthia A, Chiang Elaine L, Ansari Eman, Fleegler Eric W, Ozonoff Al, Landschaft Assaf, Kimia Amir A
Аннотация
BACKGROUND: Incision and drainage (I&D) is the standard treatment for pediatric abscesses. However, discrepancies between estimated abscess volume, determined clinically or by point-of-care ultrasound (POCUS), and the actual volume expressed may result from poor ultrasound or I&D technique. These discrepancies may lead to inappropriate management decisions and unnecessary procedures.
OBJECTIVE: To determine the prevalence of discrepancies between estimated and expressed abscess volumes during pediatric I&D.
METHODS: We conducted a cross-sectional chart review at a tertiary care pediatric emergency department (ED) between 2017 and 2023. Patients younger than or qual to 21 years with an attempted I&D were identified using a natural language processing tool. We focused on 2 groups based off of documented abscess diameter: predicted volumes of ≤1 mL and ≥10 mL. Per author discretion, these values correspond with decision-making of 'not worth pursuing I&D' and 'definitely worth pursuing I&D', respectively. We considered a positive discrepancy if for an expected abscess volume of ≤1 mL, the documented volume expressed was ≥10 mL (underestimated), and if for an expected volume of ≥10 mL, the documented volume was ≤3 mL (overestimated). Prevalence and confidence intervals were calculated using descriptive statistics.
RESULTS: Among 653 patients, 13.2% of sonographic and 7.6% of clinical estimates underestimated abscess volume, whereas 2.3% of sonographic and 19.6% of clinical estimates overestimated abscess volume. Combined assessment reduced discrepancies to 5.2% underestimated and 1.2% overestimated.
CONCLUSIONS: Combining clinical with POCUS assessment of pediatric abscesses provides better prediction of volume than reliance on a single method potentially reducing unnecessary procedures and missed I&D opportunities.
OBJECTIVE: To determine the prevalence of discrepancies between estimated and expressed abscess volumes during pediatric I&D.
METHODS: We conducted a cross-sectional chart review at a tertiary care pediatric emergency department (ED) between 2017 and 2023. Patients younger than or qual to 21 years with an attempted I&D were identified using a natural language processing tool. We focused on 2 groups based off of documented abscess diameter: predicted volumes of ≤1 mL and ≥10 mL. Per author discretion, these values correspond with decision-making of 'not worth pursuing I&D' and 'definitely worth pursuing I&D', respectively. We considered a positive discrepancy if for an expected abscess volume of ≤1 mL, the documented volume expressed was ≥10 mL (underestimated), and if for an expected volume of ≥10 mL, the documented volume was ≤3 mL (overestimated). Prevalence and confidence intervals were calculated using descriptive statistics.
RESULTS: Among 653 patients, 13.2% of sonographic and 7.6% of clinical estimates underestimated abscess volume, whereas 2.3% of sonographic and 19.6% of clinical estimates overestimated abscess volume. Combined assessment reduced discrepancies to 5.2% underestimated and 1.2% overestimated.
CONCLUSIONS: Combining clinical with POCUS assessment of pediatric abscesses provides better prediction of volume than reliance on a single method potentially reducing unnecessary procedures and missed I&D opportunities.