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Loop Drainage Is Noninferior to Traditional Incision and Drainage of Cutaneous Abscesses in the Emergency Department.
Schechter-Perkins, Elissa M; Dwyer, Kristin H; Amin, Anish; Tyler, Matthew D; Liu, James; Nelson, Kerrie P; Mitchell, Patricia M.
  • Schechter-Perkins EM; From the, Department of Emergency Medicine, Boston University School of Medicine, Boston, MA, USA.
  • Dwyer KH; the, Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA.
  • Amin A; the, Department of Emergency Medicine, Kaiser Permanante Medical Center, Oakland, CA, USA.
  • Tyler MD; the, Department of Emergency Medicine, Advocate Christ Medical Center, Oak Lawn, IL, USA.
  • Liu J; From the, Department of Emergency Medicine, Boston University School of Medicine, Boston, MA, USA.
  • Nelson KP; and the, School of Public Health, Boston University, Boston, MA, USA.
  • Mitchell PM; From the, Department of Emergency Medicine, Boston University School of Medicine, Boston, MA, USA.
Acad Emerg Med ; 27(11): 1150-1157, 2020 11.
Article in English | MEDLINE | ID: covidwho-1455493
ABSTRACT

BACKGROUND:

There is limited research on loop drainage (LD) compared to incision and drainage (I&D) for treatment of cutaneous abscesses. We investigated whether LD was noninferior to I&D for abscess resolution and whether there was any difference in repeat ED visits or complication rates between these techniques.

METHODS:

We performed a prospective randomized controlled trial, using a convenience sample at an urban academic emergency department (ED). Subjects over 18 years who presented for first-time management of an abscess were eligible. Patients requiring specialist drainage or hospital admission or had previous treatment for the abscess were excluded. Enrolled subjects were seen 2 weeks after treatment for blinded reevaluation of abscess resolution, and the electronic medical record was reviewed for return ED visits/abscess complications.

RESULTS:

Of 2,889 patients screened, 238 subjects consented and were randomized to LD or I&D. Abscess resolution was achieved in 53/65 (81.5%) of patients in the I&D arm, compared to 66/75 (88%) in the LD arm. Fewer patients in the LD group compared to the I&D group returned to the ED for abscess-related management during the following 14 days (37.3% vs 67.1%, p = 0.002). Among returning subjects, there was a significant difference in mean visits per subject between LD and I&D groups (0.5 vs. 1.2, p = 0.001). There were fewer complications among LD than I&D subjects (9.3% vs. 24.6%, p = 0.01).

CONCLUSION:

Our study provides evidence that LD is noninferior to I&D in achieving complete abscess resolution at 14 days and is associated with fewer return ED visits and fewer complications. This makes it an attractive alternative treatment option for abscesses.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Skin Diseases / Abscess Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Humans Language: English Journal: Acad Emerg Med Journal subject: Emergency Medicine Year: 2020 Document Type: Article Affiliation country: Acem.13981

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Skin Diseases / Abscess Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Humans Language: English Journal: Acad Emerg Med Journal subject: Emergency Medicine Year: 2020 Document Type: Article Affiliation country: Acem.13981