Gaspari RJ, Sanseverino A, Gleeson T, et al.
Annals of emergency medicine. Date of publication 2019 Jan 1;volume 73(1):1-7.
1. Ann Emerg Med. 2019 Jan;73(1):1-7. doi: 10.1016/j.annemergmed.2018.05.014.
Epub 2018 Aug 17.
Abscess Incision and Drainage With or Without Ultrasonography: A Randomized
Controlled Trial.
Gaspari RJ(1), Sanseverino A(2), Gleeson T(2).
Author information:
(1)Department of Emergency Medicine, UMass Memorial Medical Center, Worcester,
MA. Electronic address: romolo.gaspari@umassmemorial.org.
(2)Department of Emergency Medicine, UMass Memorial Medical Center, Worcester,
MA.
Comment in
CJEM. 2019 Jul;21(4):552-553.
STUDY OBJECTIVE: We hypothesize that clinical failure rates will be lower in
patients treated with point-of-care ultrasonography and incision and drainage
compared with those who undergo incision and drainage after physical examination
alone.
METHODS: We performed a prospective randomized clinical trial of patients
presenting with a soft tissue abscess at a large, academic emergency department.
Patients presenting with an uncomplicated soft tissue abscess requiring incision
and drainage were eligible for enrollment and randomized to treatment with or
without point-of-care ultrasonography. The diagnosis of an abscess was by
physical examination, bedside ultrasonography, or both. Patients randomized to
the point-of-care ultrasonography group had an incision and drainage performed
with bedside ultrasonographic imaging of the abscess. Patients randomized to the
non-point-of-care ultrasonography group had an incision and drainage performed
with physical examination alone. Comparison between groups was by comparing
means with 95% confidence intervals. The primary outcome was failure of therapy
at 10 days, defined as a repeated incision and drainage, following a
per-protocol analysis. Multivariate analysis was performed to control for study
variables. Our study was designed to detect a clinically important difference
between groups, which we defined as a 13% difference.
RESULTS: A total of 125 patients were enrolled, 63 randomized to the
point-of-care ultrasonography group and 62 to physical examination alone. After
loss to follow-up and misallocation, 54 patients in the ultrasonography group
and 53 in the physical examination alone group were analyzed. The overall
failure rate for all patients enrolled in the study was 10.3%. Patients who were
evaluated with ultrasonography were less likely to fail therapy and have
repeated incision and drainage, with a difference between groups of 13.3% (95%
confidence interval 0.0% to 19.4%). Abscess locations were predominantly torso
(21%), buttocks (21%), lower extremity (18%), and axilla or groin (16%). There
was no difference in baseline characteristics between groups relative to abscess
size, duration of symptoms before presentation, percentage with cellulitis, and
treatment with antibiotics.
CONCLUSION: Patients with soft tissue abscesses who were undergoing incision and
drainage with point-of-care ultrasonography demonstrated less clinical failure
compared with those treated without point-of-care ultrasonography.
Copyright © 2018 American College of Emergency Physicians. Published by Elsevier
Inc. All rights reserved.
DOI: 10.1016/j.annemergmed.2018.05.014
PMID: 30126754 [Indexed for MEDLINE]
