Abscess Incision and Drainage With or Without Ultrasonography: A Randomized Controlled Trial

Area of Science:

• Emergency Medicine
• Diagnostic Imaging
• Surgical Procedures

Background:

• Soft tissue abscesses are common, requiring incision and drainage (I&D).
• Clinical outcomes can be variable, with potential for treatment failure.
• Accurate diagnosis and effective I&D are crucial for successful management.

Purpose of the Study:

• To compare the efficacy of point-of-care ultrasonography (POCUS) with physical examination alone for guiding I&D in soft tissue abscesses.
• To determine if POCUS-guided I&D reduces clinical failure rates compared to standard I&D.
• To evaluate the impact of POCUS on the need for repeat procedures.

Main Methods:

• Prospective randomized clinical trial involving patients with soft tissue abscesses.
• Patients randomized to either POCUS-guided I&D or I&D guided by physical examination alone.
• Primary outcome: therapy failure at 10 days, defined as repeat I&D. Analysis included per-protocol and multivariate approaches.

Main Results:

• A total of 107 patients (54 POCUS, 53 non-POCUS) were analyzed after exclusions.
• The overall failure rate was 10.3%.
• The POCUS group demonstrated a 13.3% lower failure rate (95% CI 0.0% to 19.4%) compared to the non-POCUS group, indicating significantly improved outcomes.

Conclusions:

• POCUS-guided I&D for soft tissue abscesses is associated with reduced clinical failure rates.
• Utilizing POCUS improves the success of incision and drainage procedures.
• This approach offers a valuable adjunct to physical examination in managing soft tissue abscesses.