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

This study assesses outcome in pediatric patients with skin abscess using the LOOP compared to the standard incision and drainage (ID) with packing method.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.Over a 1-year period there were 233 pediatric abscesses identified: 79 cases (34%) treated with the LOOP technique and 154 cases with standard ID (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 ID. Failure rate was 1.4% in the LOOP group and 10.5% in the standard ID (P.030).There was a significant difference in failure rate between the LOOP and the standard ID groups. A prospective randomized trial is needed to confirm these results, but this novel technique shows promise as an alternative to ID with packing in the management of skin abscesses in pediatric ED patients.