Emergency Department and Inpatient Clinical Pathway for
Evaluation/Treatment of Children with Suspected Cellulitis/Abscess

Concern for necrotizing fasciitis
or severe sepsis:
ED, Inpatient, PICU Sepsis Pathway
Cellulitis
(Non-purulent)
Low concern for underlying purulence, abscess
  • Induration, edema w/o clear fluctuance
  • No history of purulent drainage
  • Fluctuance, swelling
  • History, presence of purulent drainage
Ultrasound
Bedside/Radiology
Drainable
Collection
No Drainable
Collection
Admit
Daily Re-evaluation
Clinical Improvement
No/Inadequate Clinical Improvement
After 48 hrs
  • Decreased induration, erythema, size, pain, receding from outline
  • Improving fever curve
  • Tolerating PO
  • No change or increased induration, erythema, size, pain
  • Continued fever
  • If concern for new fluctuance/evolving abscess:
    • Obtain ultrasound
    • Consult ID as needed
    • Consult General Surgery if suspected drainable collection
    • In anticipation of procedure, place NPO orders and Sedation Consult
  • Rapid progression or concern for necrotizing fasciitis
Review Antibiotics and Culture Sensitivities
  • Tailor if culture sensitivities are available
  • Not necessary to wait for sensitivities if
    adequate improvement
  • Not necessary to convert to PO antibiotics
    prior to discharge
Review Antibiotics and Culture Sensitivities
Tailor if culture sensitivities are available
Daily re-evaluation until adequate improvement