The loop technique: a novel incision and drainage technique in the treatment of skin abscesses in a pediatric ED

• Published in: The American journal of emergency medicine 2015-02, Vol.33 (2), p.271-276
• Main Authors: Ladde, Jay G., MD, Baker, Sara, MD, Rodgers, C. Neil, MD, Papa, Linda, MDCM, MSc
• Format: Article
• Language: English
• Subjects: Abscess - surgery; Adolescent; Age; Anesthesia; Antibiotics; Child; Child, Preschool; Confidence intervals; Drainage - methods; Emergency; Emergency medical care; Emergency Service, Hospital; Failure; Female; Hospitals; Humans; Infant; Male; Patients; Retrospective Studies; Skin Diseases, Infectious - surgery; Staphylococcus infections; Suture Techniques; Treatment Failure; Treatment Outcome
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2014.10.014

Abstract Objective This study assesses outcome in pediatric patients with skin abscess using the LOOP compared to the standard incision and drainage (I&D) with packing method. Methods This retrospective study used ICD-9 codes to identify pediatric patients aged 0 to 17 years with a skin abscess presenting to a level I pediatric trauma emergency department (ED). Patients requiring surgical debridement were excluded; as were patients with abscesses on the face, scalp, hands or feet. The primary outcome was failure rate, defined as those requiring admission, intravenous antibiotics, or repeat drainage. Results Over a 1-year period there were 233 pediatric abscesses identified: 79 cases (34%) treated with the LOOP technique and 154 cases with standard I&D (66%). The overall mean age of patients was 6.2 yrs: children in the LOOP group were younger than those in the standard group, 4.4 vs 7.1 years respectively ( P = .001). Abscess location also differed between the two groups; however they had a similar gender distribution and mean temperature. Of the cases identified by chart review, clinical outcome could be assessed in 143 patients (61%): 52 (36%) patients with LOOP vs 91 (64%) with I&D. Failure rate was 1.4% in the LOOP group and 10.5% in the standard I&D ( P < .030). Conclusion There was a significant difference in failure rate between the LOOP and the standard I&D groups. A prospective randomized trial is needed to confirm these results, but this novel technique shows promise as an alternative to I&D with packing in the management of skin abscesses in pediatric ED patients.