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Clinical failure in abscess treatment: the role of ultrasound and incision and drainage

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Abstract

Purpose

Skin and soft tissue abscesses are commonly treated in emergency departments (ED). The use of bedside ultrasound may improve patient outcomes. The primary objective of this study was to examine the relationship between ultrasound use and risk of treatment failure in ED patients treated for abscesses.

Methods

In this multi-center observational study, we reviewed medical records of adult patients evaluated for abscesses. Demographics, infection characteristics, treatments rendered, use of ultrasound (for diagnosis and/or treatment) and follow-up data were collected from electronic medical record review. Treatment failure, the primary outcome, was defined as any surgical intervention after the initial ED visit. Multivariable logistic regression tested whether incision and drainage utilizing ultrasound was associated with reduced treatment failure.

Results

We identified 609 patients diagnosed with abscesses over a 22-month period. Of them 75% were treated with incision and drainage, 55% had an ultrasound and 15% failed treatment. Multi-variable analysis demonstrated an 8% probability of failure with ultrasound plus incision and drainage, 14% with blind incision and drainage and 25% without incision and drainage. Individuals with incision and drainage performed were 50% less likely to fail treatment (RR 0.53, 95%CI 0.35–0.81) and 70% less likely to fail treatment (RR 0.30, 95%CI 0.18–0.51) with ultrasound and incision and drainage.

Conclusions

The use of ultrasound in diagnosing and or/treating patients with abscesses in the ED is associated with decreased treatment failure risk when utilized with incision and drainage. Consideration of ultrasound use in other studies which assess treatment methods in relation to patient outcomes may be warranted.

Résumé

Objectif

Les abcès de la peau et des tissus mous sont couramment traités dans les services d'urgence (SU). L'utilisation de l'échographie au chevet du patient peut améliorer les résultats des patients. L'objectif principal de cette étude était d'examiner la relation entre l'utilisation de l'échographie et le risque d'échec du traitement chez les patients des urgences traités pour des abcès.

Méthodes

Dans cette étude d’observation multicentrique, nous avons examiné les dossiers médicaux des patients adultes évalués pour les abcès. Les données démographiques, les caractéristiques de l'infection, les traitements rendus, l'utilisation de l'échographie (pour le diagnostic et/ou le traitement) et les données de suivi ont été recueillies à partir de l'examen des dossiers médicaux électroniques. L'échec du traitement, le critère de jugement principal, a été défini comme toute intervention chirurgicale après la visite initiale au service d'urgence. Une régression logistique multivariable a permis de vérifier si l'incision et le drainage par ultrasons étaient associés à une réduction de l'échec du traitement.

Résultats

Nous avons identifié 609 patients diagnostiqués avec des abcès sur une période de 22 mois. Parmi eux, 75 % ont été traités par incision et drainage, 55% ont eu une échographie et 15 % ont échoué le traitement. L'analyse multivariée a démontré une probabilité d'échec de 8 % avec échographie plus incision et drainage, 14 % avec incision et drainage aveugle et 25 % sans incision et drainage. Les personnes chez qui l'on a pratiqué une incision et un drainage avaient 50 % moins de risques d'échouer le traitement (RR 0,53, 95 % IC 0,35-0,81) et 70 % moins de risques d'échouer le traitement (RR 0,30, 95 % IC 0,18-0,51) avec l'échographie et l'incision et le drainage.

Conclusions

L'utilisation de l'échographie pour le diagnostic et/ou le traitement des patients atteints d'abcès aux urgences est associée à une diminution du risque d'échec du traitement lorsqu'elle est utilisée avec l'incision et le drainage. Il peut être justifié d'envisager l'utilisation de l'échographie dans d'autres études qui évaluent les méthodes de traitement en fonction des résultats pour les patients.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA

    Melissa Goulding

  2. Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA

    John Haran, Alexandra Sanseverino & Romolo Gaspari

  3. Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA

    Tyler Zeoli

Authors
  1. Melissa Goulding
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  2. John Haran
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  3. Alexandra Sanseverino
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  4. Tyler Zeoli
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  5. Romolo Gaspari
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Contributions

All authors whose names appear on the submission meet journal requirements for authorship.

Corresponding author

Correspondence to Melissa Goulding.

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Conflicts of interest

None of the authors have any conflict of interest or competing interests.

Ethics approval

The study was approved by the University of Massachusetts Medical School Institutional Review Board.

Ethical standards

This retrospective chart review study involving data collected for clinical purposes was conducted in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of University of Massachusetts Medical School approved this study.

Consent to participate

Due to the retrospective deidentified nature of this study, the approving IRB did not require consent.

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Goulding, M., Haran, J., Sanseverino, A. et al. Clinical failure in abscess treatment: the role of ultrasound and incision and drainage. Can J Emerg Med 24, 39–43 (2022). https://doi.org/10.1007/s43678-021-00179-8

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  • DOI: https://doi.org/10.1007/s43678-021-00179-8

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