210 A Retrospective Institutional Review of Vessel Loops for Incision and Drainage of Abscesses in the Pediatric Emergency Department

Abstract

Subcutaneous abscesses frequently present to the pediatric emergency department (PED). The gold standard for abscess management is incision and drainage (I&D) with packing. Abscesses that have been packed may be painful; and repeat packing procedures are also distressing. An alternative management is I&D with placement of a vessel loop. Currently, there is little data available regarding its use in the PED. The primary objective of this study was to evaluate the practice change in abscess drainage from I&D with packing to vessel loops over a 6-year period. The secondary objective was to compare return visits and complication rates among the pre- and post-vessel loops implementation groups. This was a retrospective cross-sectional descriptive study of abscess management in a single tertiary care PED before and after introduction of vessel loops. Patients > 28 days-17 years were included if presenting with a subcutaneous abscess requiring an I&D in the PED. Patients were excluded if immunocompromised, the abscess was drained manually or by needle aspiration, or if a subspecialist performed the drainage. ICD-9 codes for “cellulitis” and “abscess” and a procedure code for “incision and drainage” were used to screen patients from November 2008-November 2014. Included patients were divided into an 18-month pre-vessel loop group and an 18-month post-vessel loop group. The 3-year time frame when vessel loop technique was implemented was excluded. Demographics, abscess characteristics and management, and return visits/complications were collected. Complications were defined as: return visit, repacking of abscess, repeat I&D, or return visit with admission. 224 patients were included in the pre-vessel loop group and 194 patients in the post-vessel loop group. The pre-vessel loop group had a mean age of 4.8 years, 40% male, and 42% buttocks abscess, and the post-vessel loop had a mean age of 4.9 years, 42% male, and 45% buttock abscesses. In the pre-vessel loop group, 81.6% had I&D with packing, 18.4% had I&D without packing, and none had vessel loop placement. In the post-vessel loop group 14.4% underwent I&D with packing, 28.9% underwent I&D without packing, and 56.7% had vessel loop placement. There were 54 (24%) return visits for the pre-vessel loops group and 18 (9.3%) return visits for the post-vessel loops group, 14.7% difference in rates, 95% CI of 7.5% to 22%. p <0.001. Abscesses were repacked 22 times (10%) in the pre-vessel loop group and none in the post-vessel loop group (p<0.001). The groups demonstrated no difference between return visits with admission (2.7% vs 2.1%, p=0.26) or repeat I&D (2.74% vs 1.5%, p= 0.68). During the study, provider use of I&D with packing decreased and vessel loops increased. There was no increase in complication/treatment failures, and return PED visits for abscess re-packing significantly decreased.