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Pediatr Emerg Care. 2019 Mar 4. doi: 10.1097/PEC.0000000000001732. [Epub ahead of print]

Comparison of Minimally Invasive Loop Drainage and Standard Incision and Drainage of Cutaneous Abscesses in Children Presenting to a Pediatric Emergency Department: A Prospective, Randomized, Noninferiority Trial.

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Department of Emergency Medicine, Boston University School of Medicine, Boston, MA.



This study aimed to determine whether the treatment of skin abscesses with vessel loop drainage is noninferior to standard incision and drainage (I&D) regarding treatment failure in pediatric patients in the emergency department (ED).


This study was a prospective, randomized controlled trial in a pediatric ED of an urban tertiary pediatric hospital. Patients with a skin abscess were enrolled. Subjects were assigned to the control arm of I&D or the study arm of vessel loop drainage. Study end points (failure rates, satisfaction scores, wound appearance, visit frequency) were assessed before discharge from the ED, at 24- to 48-hour follow-up, and at 14-day follow-up. Treatment failure was declared if the abscess required reinstrumentation or admission for intravenous antibiotics for systemic illness within 14 days.


From August 2014 to October 2015, 81 patients completed this study. Treatment failure was observed in 3 subjects of each arm (7.3% loop vs 7.5% standard; risk difference, 0.2%; 95% confidence interval, -11.2% to 11.6%). Parent satisfaction rates with wound appearance at day 14 were similar (86.1% loop vs 88.2% standard were at least satisfied). Median cosmetic scores were similar at day 14 (6 [interquartile range {IQR}, 5-6] loop vs 6 [IQR, 5-6] standard, where 6 was optimal). Follow-up visit frequency was similar (2 [IQR, 2-3] loop vs 2 [IQR, 2-2.5] standard).


Abscess drainage with a vessel loop in the pediatric ED results in failure rates noninferior to those of the standard I&D. Satisfaction and cosmetic scores are favorable in both groups.

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