EBQ:Irrigation of Cutaneous Abscesses Does Not Improve Treatment Success
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incomplete Journal Club Article
Chinook B, Henley G. "Irrigation of Cutaneous Abscesses Does Not Improve Treatment Success". Annals of Emergency Medicine. 2016. 67(3):379-383.
PubMed Full text PDF
PubMed Full text PDF
Clinical Question
Does irrigation of cutaneous abscesses in the ED reduce the need for further intervention?
Conclusion
Irrigation of cutaneous abscesses after standard incision and drainage does not decrease the need for further intervention, and may be unnecessary.
Major Points
Study Design
Prospective, randomized, non blinded, single center trial comparing irrigation with no irrigation. The study was conducted in an academic ED with an annual census of ~110,00 patients.
Population
Patient and Abscess Baseline Characteristics
| Patient Characteristics | Irrigation (95) | No Irrigation (92) |
| Median Age | 35 | 40 |
| Cellulitis | 61% | 51% |
| Diabetes | 17% | 16% |
| Fever | 3% | 2% |
| Immunocompromised | 3% | 2% |
| Abscess Size | Irrigation | No Irrigation |
| Median | 4.6 cm Irrigation | 4.3 cm No Irrigation |
| Range | 3-10 cm Irrigation | 1-11 cm No Irrigation |
| Abscess Location | Irrigation | No Irrigation |
| Face, Scalp | 5% | 9% |
| Neck | 3% | 5% |
| Chest, Breast, Back, Abdomen, Inguinal | 13% | 22% |
| Buttocks | 20% | 16% |
| Perineum, Perianal, Labial, Scrotal | 7% | 4% |
| Leg, foot | 19% | 21% |
| Post Procedure | Irrigation | No Irrigation |
| Abscess Packed | 89% | 75% |
| IV ABX in ED | 3% | 8% |
| PO ABX in ED | 42% | 43% |
| ABX Rx’d | 91% | 73% |
Inclusion Criteria
- Patients over the age of 18 with a cutaneous abscess
Exclusion Criteria
- Pregnancy
- In police custody or prison resident
- Patients admitted to the hospital
- Operating room I&D
- Inability to follow up in 48 hours, or to provide contact information for 30 day follow up