R.E.B.E.L.EM - April 11, 2016 - Posted by Anand Swaminathan
Background: Irrigation after incision and drainage (I&D) of an abscess in the ED is considered by some sources to be standard care but local practice varies considerably. There are no randomized controlled trials to date that look at the potential benefits of this procedure. Irrigation increases the time required for the procedure and increases pain experienced by the patient.
Clinical Question: Does irrigation of the abscess cavity after I&D reduce the need for further intervention (repeated I&D, antibiotic change, abscess-related hospital admission)?
Article: Chinnock B, Hendey GW. Irrigation of cutaneous abscesses does not improve treatment success. Ann Emerg Med 2016; 67(3): 379-83. PMID: 26416494
Authors Conclusions: “Although there were baseline differences between groups, irrigation of the abscess cavity during incision and drainage did not decrease the need for further intervention.”
Our Conclusions: We agree with the authors interpretation of the data in this study. Irrigation does not appear to improve outcomes after incision and drainage of abscesses. While this is the largest, best done study on the topic to date, it has significant flaws. A larger study with a clearer protocol (who gets antibiotics? who needs packing?) will shed more light on the topic.
Potential to Impact Current Practice: As it stands, current practice appears to vary considerably. For providers who routinely perform irrigation after incision and drainage, this study is unlikely to be enough to change practice. Alternatively, for providers who do not routinely perform irrigation, this study serves to defend that approach.
Clinical Bottom Line:
In the absence of better evidence, it does not appear that irrigation and the accompanying time, resources and potential pain inflicted on patients is necessary to improve outcomes in abscess management.