Incision and Drainage Versus Needle Aspiration in Soft Tissue Abscesses

Study Overview
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Brief Summary
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The incidence of skin and soft tissue infections has increased dramatically over the last decade, in part due to increased prevalence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA). Incision and drainage (I&D) is considered the primary intervention, however some clinicians prefer ultrasound guided needle aspiration (US Asp). The investigators performed a randomized trial comparing US Asp to I&D for uncomplicated skin and soft tissue abscesses, with a subgroup analysis of patients with CA-MRSA.

Official Title
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Ultrasound Guided Needle Drainage Versus Formal Incision and Drainage of Superficial Soft Tissue Abscesses in the Emergency Department Setting

Conditions
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Abscess, Cellulitis

Intervention / Treatment
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* Procedure: Incision and Drainage
* Procedure: Ultrasound Guided Aspiration


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: presenting to emergency department with skin abscess abscess required surgical drainage healthy appearing Exclusion Criteria: pregnant unable to give consent abscess located in oral cavity abscess located on genitalia abscess located intra-gluteal at coccyx

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Incision and Drainage<br>Abscess underwent incision and drainage | Procedure: Incision and Drainage<br>* Surgical incision of the skin surface followed by expression of purulence with or without debridement or manual exploration of abscess cavity.<br>|
| Active Comparator: Ultrasound guided needle aspiration<br>Ultrasound was used to identify the abscess location. A needle was introduced into the abscess cavity and aspiration of the contents were attempted. | Procedure: Ultrasound Guided Aspiration<br>* Ultrasound is used to identify the abscess cavity. An 18 gauge needle is introduced into the abscess cavity and manual aspiration of the abscess contents is attempted.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Successful drainage of abscess | Clinical outcome at 7 days | 7 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Successful drainage of abscess | Healing of abscess following drainage procedure at day 2 | 2 days | 
| Ability to evacuate purulence from abscess | Amount of purulence produced by drainage procedure on day 1 | Day 1 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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abscess, infection, ultrasound guidance, incision and drainage, needle aspiration, skin, ultrasound