M. Veenstra1,2, A. Hartner2, B. Kumar2, P. Mahajan2, B. Asmar2, M. Klein1,2 1Detroit Medical Center,Detroit, MI, USA 2Children’s Hospital Of Michigan,Pediatric Surgery,Detroit, MI, USA
Introduction:
Skin and soft tissue infections (SSTIs) have increased in the past 2 decades and are associated with increasing health care costs. We convened a multispecialty group of physicians from the departments of surgery, pediatrics, emergency medicine, and infectious disease to evaluate our experience and costs related to evaluation of pediatric SSTIs.
Methods:
Patients (682) who presented to our ED with SSTIs during 6 consecutive months (July-December 2012) were reviewed for resource utilization and costs. This data was compared to current recommendations in the literature to identify evaluation tools that add resource consumption without benefit to the patient. ANOVA was used for statistical analysis.
Results:
Of the 682 patients presenting with a pediatric SSTI, 331 (49%) underwent incision and drainage for an abscess. Wound cultures were completed in 38% of patients, blood cultures in 29%, US in 16%, antibiotics prescribed to 97%, and 208 patients (30%) were admitted to the hospital. The mean direct cost per patient was $792.66 and mean length of stay was 15 hours. The total direct cost of care for 6 months was $540,593. The use of ultrasound, wound culture, and blood culture increased the length of stay (p<0.01) and all resources increased cost for patients (p<0.01). Patients admitted to a surgical service had a shorter length of stay and lower cost than those admitted to a non-surgical service (p<0.01).
Conclusion:
We noted many resources that are being overutilized in the evaluation of pediatric patients with SSTI that are contributing to unnecessary costs when compared to recommendations in the literature. The include blood cultures, wound cultures, and the use of utrasound.