Packing of Abscesses after Incision and Drainage to Prevent Recurrent/Repeat Infection
Benefits in NNT
None were helped (preventing abscess/repeat needed intervention)
100% saw no benefit
0% were helped by preventing a need for a secondary intervention
0% were helped by prevention of a recurrent abscess
Harms in NNT
An unknown number were harmed (increased pain: on average, patients experienced significantly increased pain in the groups undergoing packing; the average increase in pain due to packing was 24mm (VAS) during the procedure.)
An unknown number were harmed by increased pain (on average, patients experienced significantly increased pain in the groups undergoing packing; the average increase in pain due to packing was 24mm (VAS) during the procedure.)
SourceO’Malley GF, Dominici P, Giraldo P, et al. Routine packing of simple cutaneous abscesses is painful and probably unnecessary. Acad Emerg Med 2009;16:470-473.
Barnes SM and Milsom PL. Abscess: an open and shut case. Arch Emerg Med 1988;5:200-205.
Efficacy EndpointsPrevention of need for secondary intervention (for example, repeat incision and drainage); prevention of recurrent abscess
Harm EndpointsPain during packing/removal of packing
NarrativeThe management of abscesses has classically included incision and drainage of the lesion followed by the insertion of packing material into the cavity. Patients are typically told to return to the ED 48 hours later, at which point the packing is removed and, occasionally, new packing inserted. Multiple textbooks support this approach and describe packing as critical in preventing recollection of pus. It is believed that packing absorbs pus and debris and prevents premature closure of the incision, leaving a route of egress for pus.
Surprisingly, there is only one randomized, controlled trial evaluating the utility of packing in simple cutaneous abscesses managed in the ED setting1. The sample size is small (n = 48), the methods are good, and outcome assessments were blinded. Of note, all subjects were prescribed antibiotics. At 48 hours, 17% in the packing group and 20% in the nonpacking group received a secondary intervention (p = 0.72), although use of these interventions was left to judgment and most were of questionable clinical utility.
In this study pain scores were evaluated, with an average difference in pain scores post-procedure and at two days of 23.8 mm (95% CI, 5-42 mm) and 16.4 mm (95% CI, 1.6-31.2 mm), respectively, in favor of not receiving packing.