Marks first large adult U.S. prospective randomized controlled trial comparing efficacy of a common Emergency Department procedure
AUSTIN, TX July 27, 2020
Skin infections including abscesses are the 7th most common reason for Emergency Department visits in the U.S. today, accounting for approximately 3.4 million visits and $400 million in direct costs per year.
The Journal of Academic Emergency Medicine recently published promising results of a U.S. prospective randomized controlled trial comparing the efficacy of abscess treatment utilizing either incision and drainage (I&D, control group) or loop draining (LD, study group). The study design was prospective, single-blind, two-arm, noninferiority, with 238 consented patients. It was conducted over 4 years at the Boston Medical Center, where an average of 150 abscesses are treated per month. The primary outcome of the study was abscess resolution at 14 days, with secondary endpoints of hospital revisits before resolution, and unanticipated complications/interventions.
- Abscess resolution in 81.5% of the I&D patients and 88% of the LD patients (p<0.0035) demonstrating noninferiority of the loop drainage technique.
- Statistically significant difference in abscess-related return hospital visits during the 14 day period, favoring the loop drainage group (29.8% returned for LD, 57.9% returned for I&D - p<0.001).
- Significantly less overall complications among the LD subjects than the I&D subjects (9.3% vs 24.6%, p=0.01)
- Significantly less antibiotics used in the LD subjects than the I&D subjects (1.3% vs 12.3%, p=0.01)
“This study is meaningful because it is one of the first to show that the loop procedure is at least as effective as the well-known and more invasive I&D procedure”, said study lead author, Elissa Schechter-Perkins, M.D., MPH. “These findings show that both procedures obtain abscess resolution at high rates, but LD had significantly fewer complications and return visits to the hospital, suggesting that LD may be a better option for patients and hospitals”.
Abscesses can occur in any kind of tissue, though are most frequently found in the skin surfaces (back, chest, face, buttocks are most common). Symptoms include redness, pain, and swelling caused by a bacterial infection. Treatment for skin abscesses has historically been performed with an incision across the affected area to drain fluid, followed by insertion of sterile packing material into the area that can absorb ongoing fluid drainage. In this scenario, the patient will often need to return to a care provider to remove the packing material, check the area, and usually repack the wound up to 5 times for full resolution. This procedure and sequence can be painful for the patient, lengthy in total duration, and expensive for all involved, with a high failure rate.
“As a clinician that treats multiple skin abscesses every month, it is important to keep perspective on minimizing patient visits to the hospital, particularly in a Covid-19 landscape, while also maximizing patient comfort and home-care potential”, said Matthew Wilkinson, M.D., MPH, FAAP, FACEP, Associate Professor and Research Director at the UT Austin Dell Medical School Pediatric Emergency Medicine Fellowship in Austin, TX, and the Chief Clinical Officer at EM Device Lab. “The I&D procedure is dominantly used today even though it is more invasive, often quite painful, and involves multiple trips back to the hospital for repacking of the wound. We’ve been using the loop procedure in lieu of I&D in my hospital for about 10 years, and it has dramatically improved the efficiency and quality of care we can provide to our patients in just one visit. We believe this should become the standard of care moving forward in all emergency departments.”
EM Device Labs of Austin, TX has developed an innovative solution for the loop drainage procedure with their Quickloop Abscess Treatment device, scheduled to launch in early 2021. Quickloop features a needle with a patented cutting blade, attached to drainage and irrigation tubing that can be flushed and fully locked before safely securing it to the patient. The Quickloop procedure takes about 3 minutes with no extra supplies needed, and no return visits to the hospital. Quickloop is uniquely positioned to headline the loop drainage space for abscess treatment next year. For additional information, visit www.emdevicelab.com.