20 - Expert Consensus For Treatment Of Uncomplicated Cellulitis In Pediatric Populations

Poster Number: 20
Publication Number: 20.405

Jana Jaffe, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Grace St Cyr, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Maxwell McMahon, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States; Todd A. Florin, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Wee-Jhong Chua, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States

Background: Cellulitis is a common infectious reason that children present to the emergency department (ED). Consensus is lacking on criteria used to guide clinical decisions on route of antibiotic administration and disposition.

Objective: To establish expert consensus on features used to determine the route of antibiotic administration and disposition in the treatment of uncomplicated cellulitis.

Design/Methods: Modified Delphi methodology was performed with a two-round confidential survey of ED providers (attendings, fellows, pediatric faculty) at Lurie Children’s Hospital. Using a 9-point Likert scale, participants ranked clinical and non-clinical features by their perceived level of importance when deciding if a patient requires intravenous (IV) antibiotics for uncomplicated cellulitis. Responses were grouped: not important (1-3), neutral (4-6), and important (7-9). The second-round survey summarized Round 1 results, including the majority response for each item, and then requested re-evaluation from the participants. During Round 1, participants were able to add additional factors that they deemed important in an open-ended fashion for inclusion in Round 2. Using standard Delphi methodology, consensus for each feature was defined as ≥70% agreement.

Results: Seventeen of the initial twenty-five respondents completed both surveys. Consensus was reached on 15 of 16 (93.8%) features (Table 1). Two features were deemed unimportant, ten important, and three neutral. One factor (age cutoff) did not reach consensus. Among factors deemed important, experts had the highest level of consensus (100% agreement) on presence of fevers/chills, lymphangitis, and functional impairment.Conclusion(s): This study developed expert consensus on important factors for the treatment and disposition for patients with uncomplicated cellulitis. These features will inform future studies and the development of a clinical prediction tool to aid decision-making in children with uncomplicated cellulitis.
Table 1: Survey Results