Ladde J, Baker S, Lilburn N, Wan M, Papa L, et al.
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. Date of publication 2020 Dec 1;volume 27(12):1229-1240.
1. Acad Emerg Med. 2020 Dec;27(12):1229-1240. doi: 10.1111/acem.14106. Epub 2020
Oct 11.
A Randomized Controlled Trial of Novel Loop Drainage Technique Versus Standard
Incision and Drainage in the Treatment of Skin Abscesses.
Ladde J(1), Baker S(1), Lilburn N(2), Wan M(3), Papa L(1).
Author information:
(1)From the, Department of Emergency Medicine, Orlando Regional Medical Center,
Orlando, FL, USA.
(2)the, Pasco County Emergency Physicians, Morton Plant North Bay Hospital, New
Port Richey, FL, USA.
(3)and the, Department of Emergency Medicine, Dekalb Medical Center, Atlanta,
GA, USA.
Comment in
Acad Emerg Med. 2021 Jul;28(7):810-813.
OBJECTIVES: The objective was to compare the failure rate of incision and
drainage (I&D) with LOOP technique versus I&D with standard packing technique in
adults and children presenting to the emergency department (ED) with
subcutaneous abscess.
METHODS: This prospective, randomized controlled trial (NCT03398746) enrolled a
convenience sample of patients presenting to two Level 1 trauma centers over
12 months with skin abscesses. Of 256 patients screened, 217 patients were
enrolled, 109 randomized to I&D with packing (50%) and 108 (50%) to I&D with
LOOP. The primary outcome was treatment failure defined by admission, IV
antibiotics, or repeat drainage within 10-day follow-up. The secondary outcomes
included ease of procedure, ease of care, pain, and satisfaction using a
10-point numeric rating scale.
RESULTS: There were no differences in patient characteristics between groups.
Follow-up data were available in 196 (90%). Treatment failure occurred in 20%
(range = 12%-28%) of packing patients and 13% (range = 6%-20%) of LOOP patients
(p = 0.25). There were no significant differences in failure rates in adults
(p = 0.82), but there was a significant difference in children (age ≤ 18 years)
at 21% (range = 8%-34%) in the packing group and 0 (0%) in the LOOP group
(p = 0.002). Operators reported no significant differences in ease of procedure
between techniques (p = 0.221). There was significantly less pain at follow-up
in the LOOP group versus packing (p = 0.004). The wound was much easier to care
for over the first 36 hours in the LOOP group (p = 0.002). Patient satisfaction
at 10 days postprocedure was significantly higher in the LOOP group (p = 0.005).
CONCLUSIONS: The LOOP and packing techniques had similar failure rates for
treatment of subcutaneous abscesses in adults, but the LOOP technique had
significantly fewer failures in children. Overall, pain and patient satisfaction
were significantly better in patients treated using the LOOP technique.
© 2020 by the Society for Academic Emergency Medicine.
DOI: 10.1111/acem.14106
PMID: 32770686 [Indexed for MEDLINE]
