Loop Drainage Is Noninferior to Traditional Incision and Drainage of Cutaneous Abscesses in the Emergency Department

• Published in: Academic emergency medicine Vol. 27; no. 11; pp. 1150 - 1157
• Main Authors: Schechter‐Perkins, Elissa M., Dwyer, Kristin H., Amin, Anish, Tyler, Matthew D., Liu, James, Nelson, Kerrie P., Mitchell, Patricia M., Kuehl, Damon R.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-11-2020
• Subjects: Abscess - surgery; Abscesses; Clinical trials; Drainage; Emergency medical care; Emergency Service, Hospital; Humans; Medical procedures; Prospective Studies; Skin Diseases - surgery
• ISSN: 1069-6563; 1553-2712
• DOI: 10.1111/acem.13981

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.