A Randomized Comparison Study of Minimally Invasive Loop Drainage Versus Standard Incision and Drainage for Skin Abscesses in Children

BACKGROUND INFORMATION:

Infections of skin and soft tissue remain one of the more common chief complaints in the pediatric emergency department. With methicillin-resistant Staphylococcus aureus being a prevalent pathogen, abscess development is not uncommon. The emergency department remains the common setting for required therapeutic intervention. However, active investigation exists in regard to the ideal intervention for children and adults.

Incision and drainage of cutaneous abscess has remained the standard of care for years. However this standard has been adopted without robust supportive evidence. Recently, various studies have questioned the benefit of various aspects of treatment, including antibiotics, incision size, and necessity for packing. Other studies have even suggested a less-invasive approach. Some of these have utilized a vessel loop and have demonstrated a reduced need for home-health visits, reduced inpatient length of stay, good patient tolerance, and no increase in failure rates. These studies are, however, retrospective in design with execution primarily by the surgical team.

STUDY DESCRIPTION:

Upon obtaining written informed consent/assent by the study team member, subjects will be randomized using a computerized randomization procedure and opaque envelopes. Initially, thorough history and physical exam will be performed. A data sheet will be completed detailing patient characteristics (eg. age, gender, ethnicity, prior treatment) and wound characteristics (eg. greatest diameter of both erythema and induration, presence of spontaneous drainage, location). Pain control/procedural sedation will be selected at the discretion of the treating physician, consistent with current local practice (eg. topical lidocaine, intranasal fentanyl and/or midazolam, oral acetaminophen/hydrocodone or ibuprofen, intravenous ketamine, morphine, or fentanyl). Pain will be assessed prior to physical exam and again shortly after the procedure via the validated FACES-Revised Pain Scale. The patient will provide this assessment if 5 years or older. Otherwise, the parent will provide the degree of pain perceived for their child. The difference between these two pain assessments will be evaluated as an endpoint. Physicians will report on their satisfaction with the procedure using a 5-point Likert scale.