Inpatient Clinical Pathway for the Evaluation/Treatment
of
Children with Suspected Cellulitis/Abscess
General Surgery | Breast Perianal Perineal Pilonidal Large, complex |
---|---|
ENT | Neck |
Ophtho/ENT | Orbital Periorbital |
Orthopedics | Septic arthritis Tenosynovitis Osteomyelitis |
Dental/OMFS | Facial cellulitis due to dental infection |
- Review
- History and Physical, ED Care
- Laboratory, Imaging
- Cultures If Available
- Antibiotics, I&D
- Distinguishing Cellulitis from Inflammation associated with Subcutaneous Abscess
- Ultrasound Findings of Abscess
Daily Re-evaluation
Vital Signs, Fever Curve
Clinical Exam
Pain
PO Intake
Culture Results
Laboratory Testing
Analgesia/Supportive Care
Vital Signs, Fever Curve
Clinical Exam
Pain
PO Intake
Culture Results
Laboratory Testing
Analgesia/Supportive Care
Clinical Improvement
No/Inadequate Clinical Improvement
- Decreased: induration, erythema, size, pain, receding from outline
- Improving fever curve
- Tolerating PO Intake
- Increased or no change: induration, erythema, size, pain after 48 hours
- Continued fever
- New fluctuance
- Review Antibiotics/Culture Sensitivities
- Tailor if culture sensitivities are available
- Not necessary to wait for sensitivities if adequate clinical improvement
- Always use narrowest spectrum available
- Conversion to PO antibiotics prior to discharge is not necessary
- Review Antibiotics/Culture Sensitivities
- Tailor if culture sensitivities are available
- Concern for New Fluctuance/Evolving Abscess
- Obtain ultrasound
- Consult General Surgery if drainable collection
- In anticipation of procedure, place NPO orders and a sedation consult
- No Improvement after 48 Hours
- Consider empiric antibiotic change
- Consult ID as needed
- Rapid Progression, Toxicity
- ID Consult
- Sepsis Pathway, ED, Inpatient, PICU
Daily Re-evaluation
until Adequate Improvement
until Adequate Improvement
- Discharge Criteria
- Clinical improvement on empiric antibiotics or known sensitivities
- Improving fever curve
- Tolerating PO
- Pain control
- Antibiotic course for 5 days after clinical improvement noted
- PMD follow-up assured in 72 hours
Posted: March 2015
Revised: September 2020
Authors: L. McAndrew, MD; S. Helman, MSN; C. Christian, MD; L. Utidjian, MD; J. Lavelle, MD;
N. Washington, MD; K. Henry, MD; S. Coffin, MD; P. Mattei, MD; K. Chiotos, MD
Revised: September 2020
Authors: L. McAndrew, MD; S. Helman, MSN; C. Christian, MD; L. Utidjian, MD; J. Lavelle, MD;
N. Washington, MD; K. Henry, MD; S. Coffin, MD; P. Mattei, MD; K. Chiotos, MD