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Background: Administration of PO contrast within 2 hours before sedation for abdominal computed tomography (CT) is controversial because it violates American Society of Anesthesiologists guidelines that recommend 2 hours of fasting for clear fluids before sedation., Objective: This study aimed to review the administration of PO contrast for patients undergoing propofol sedation for abdominal CT and to evaluate the impact of violation of traditional 2-hour NPO guidelines on care., Methods: Sedation records were reviewed from January 2010 to October 2011 from all patients who received PO contrast within 2 hours of propofol sedation for abdominal CT. A control group of patients receiving intravenous contrast only before propofol sedation and abdominal CT was reviewed. Demographics, time between PO contrast administration and sedation, and amount of PO contrast were recorded. Outcome measures including success of sedation and adverse events (vomiting, suctioning, use of O₂ or advanced airway, unplanned admissions) were recorded., Results: Eighty-five patients received PO contrast within 2 hours before sedation for abdominal CT; 21 controls were identified. No differences in demographics or outcome measures were seen. No significant differences were seen in rates of interventions or adverse outcomes between groups. Median time between the successive PO contrast doses and propofol administration was 1.6 hours and 0.6 hours., Conclusions: Administering oral contrast material within 2 hours of propofol sedation for abdominal CT in children seems to be relatively safe compared with those sedated after traditional NPO time frames.

Objective: To describe the management of afebrile neonatal skin and soft tissue infections (SSTIs) in the pediatric emergency department (PED)., Methods: This is a retrospective cohort study of all patients aged 0 to 28 days seen in the PED for SSTIs from 2004 to 2010. The SSTIs were identified from the International Classification of Diseases, Ninth Revision codes of pustulosis, cellulitis, and abscess. Records were reviewed to determine the absence of fever; anatomical location; cultures of blood, urine, and cerebrospinal fluid; antibiotic usage; and return visits. Data were analyzed to compare admitted versus discharged patients with SSTI subtypes., Results: Of the 136 neonates identified, 104 met inclusion criteria. Afebrile SSTIs included 8 pustulosis, 45 cellulitis, and 51 abscesses. Blood cultures were obtained in 13% of pustulosis, 96% of cellulitis, and 69% of abscesses. No serious bacterial infection was noted. Three blood cultures grew contaminants. Parenteral antibiotics for neonates with pustulosis, cellulitis, and abscesses were given in 13%, 87%, and 59%, respectively. Admission rates for neonates with pustulosis, cellulitis, and abscesses were 13%, 84%, and 55%, respectively. Cases of cellulitis were more likely to have blood cultures drawn (odds ratio [OR], 13.7; 95% confidence interval [CI], 3.03-62.3), receive intravenous antibiotics (OR, 5.87; 95% CI, 2.16-15.0), and be admitted to the hospital (OR, 5.62; 95% CI, 2.16-14.6) as compared with the other SSTI subtypes., Conclusions: None of the neonates who had cultures drawn had serious bacterial infection. The SSTI subtype correlated with the extent of evaluation and dispositions. The findings of this study will help with management strategies for afebrile neonates with SSTIs in the PED.

Objective: To determine the characteristics of pediatric soft tissue abscesses that result in hospital admission., Methods: All visits for soft tissue abscesses to the study emergency department (ED) were examined during 2008. Detailed records were reviewed to determine ED disposition, abscess size, location, presence of fever, duration of symptoms, previous antibiotic therapy, prior ED visit(s), and wound and blood culture results. Data were analyzed to determine which of these characteristics were associated with hospital admission from the ED., Results: Six hundred twenty-two patients met the inclusion criteria. One hundred thirteen (18%) patients were admitted to the hospital and 509 (82%) were discharged home. Compared to those sent home, abscesses resulting in admission were more likely to be located in the genital area (odds ratio [OR], 3.08; 95% confidence interval [CI], 1.37-6.90), breast (OR, 4.8; 95% CI, 1.08-21.4), or face (OR, 4.39; 95% CI, 1.86-10.3), and were more likely to be larger than 3 cm (OR, 3.66, 95% CI, 2.10-6.36). Patients who were admitted to the hospital were also more likely to have fever (OR, 5.93; 95% CI, 3.4-10.3) and have had a prior ED visit with the same complaint (OR, 3.81; 95% CI, 1.77-8.2). Seventy-seven percent of abscesses that were cultured were positive for methicillin-resistant Staphylococcus aureus., Conclusions: Size and location (especially those in the genital region, breast, and face), appear to be associated with admission for pediatric abscesses. History of fever and previous ED visit also appear to be associated with hospital admission. Obtaining blood cultures for pediatric abscesses is likely of little clinical benefit., (Copyright © 2011 Elsevier Inc. All rights reserved.)