Infectious Disease
Topic 1 - Summary | |
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1. Citation: |
Conflicting data regarding use of steroids in CAP |
2. Summary/Bottom Lines: |
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3. Methods: |
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4. Discussion and conclusions |
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5. Additional Info: |
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6. Author: | Dr. Stephen Howard |
Topic 2 - Summary | |
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1. Citation: |
Tsoraides SS, Pearl RH, Stanfill AB, et al. Incision and loop drainage: a minimally invasive technique for subcutaneous abscess management in children. J Pediatric Surgery. 2010 March; 45(3):606-609. |
2. Summary/Bottom Lines: |
This paper presented a new technique for the management of simple abscess in pediatric surgery patients involving placement of a loop vessel. Two small incisions on opposite sides of abscess are made, pus is evacuated, cavity irrigated, and then a loop vessel is placed through the incisions and loosely tied above the skin. They argue this is more practical in the pediatric population given the difficulties of repetitive packing and wound care associated with the classic technique. They found their technique to have an acceptably low re-operation rate and hypothesize that this technique would also be more cost effective. |
3. Methods: | Retrospective study preformed at academic center on all pediatric patients who underwent procedure between Jan-02 & Oct-07. All procedures performed by 1 of 3 surgeons. Outcomes: demographic information, duration of symptoms, location of abscess, type of drain used, length of procedure, cultured bacteria, drain duration, antibiotic use, complications. 115 patients total. 5 excluded for pilonidal abscess. 13 lost to follow up. Report re-operation rate at 6/110, despite 13 lost to follow up. No other predictors identified. |
4. Limits: | This paper is limited by it's retrospective nature and the lack of a control. Additionally, the improper inclusion of the lost to follow up patients in their main data point (re-operation rate) was an oversight. All of these patients where admitted to the general surgery service, the procedure was performed in the OR, and all most every patient received antibiotics. None of these features are consistent with our practice in the ED. |
5. Additional Info: |
My take is that this is mostly a "hey, look what we did" paper. While the results are interesting, it doesn't prove anything. A prospective trail with comparison to the standard technique is required. Dr. Nelson agreed. Dr. Maldonado mentioned this technique was presented at a conference he attended recently. While he thinks it is interesting and it might have potential, there isn't enough evidence to convince him to change his practice. |
6. Author: | Dr. Brandon Charlton |