Comparison of Minimally Invasive Loop Drainage and Standard Incision and Drainage of Cutaneous Abscesses in Children Presenting to a Pediatric Emergency Department: A Prospective, Randomized, Noninferiority Trial.

OBJECTIVE: This study aimed to determine whether the treatment of skin abscesses with vessel loop drainage is noninferior to standard incision and drainage (I&D) regarding treatment failure in pediatric patients in the emergency department (ED). METHODS: This study was a prospective, randomized controlled trial in a pediatric ED of an urban tertiary pediatric hospital. Patients with a skin abscess were enrolled. Subjects were assigned to the control arm of I&D or the study arm of vessel loop drainage. Study end points (failure rates, satisfaction scores, wound appearance, visit frequency) were assessed before discharge from the ED, at 24- to 48-hour follow-up, and at 14-day follow-up. Treatment failure was declared if the abscess required reinstrumentation or admission for intravenous antibiotics for systemic illness within 14 days. RESULTS: From August 2014 to October 2015, 81 patients completed this study. Treatment failure was observed in 3 subjects of each arm (7.3% loop vs 7.5% standard; risk difference, 0.2%; 95% confidence interval, -11.2% to 11.6%). Parent satisfaction rates with wound appearance at day 14 were similar (86.1% loop vs 88.2% standard were at least satisfied). Median cosmetic scores were similar at day 14 (6 [interquartile range {IQR}, 5-6] loop vs 6 [IQR, 5-6] standard, where 6 was optimal). Follow-up visit frequency was similar (2 [IQR, 2-3] loop vs 2 [IQR, 2-2.5] standard). CONCLUSIONS: Abscess drainage with a vessel loop in the pediatric ED results in failure rates noninferior to those of the standard I&D. Satisfaction and cosmetic scores are favorable in both groups.

An Anaphylactoid Reaction to Rattlesnake Envenomation in a Pediatric Patient.

Rattlesnake envenomation causes a spectrum of symptoms and signs, many of which closely resemble an anaphylactic reaction. Development of airway compromise after a snake bite to an extremity is unusual, but has been previously reported. The majority of such reports detail a history of probable sensitization from previous contact with snakes or snake venom. Few reports exist without such previous contact; no reports are of pediatric cases. Here we present a 14-year-old boy with no history of prior snake exposure who presents with an anaphylactoid reaction after a rattlesnake bite.