The treatment of cutaneous abscesses: Comparison of emergency medicine providers' practice patterns

Gillian Schmitz, Tress Goodwin, Adam Singer, Chad S. Kessler, David Bruner, Hollynn Larrabee, Larissa S May, Samuel D. Luber, Justin Williams, Rahul Bhat

Research output: Contribution to journalReview article

16 Citations (Scopus)

Abstract

Introduction: Cutaneous abscesses are commonly treated in the emergency department (ED). Although incision and drainage (I&D) remains the standard treatment, there is little high-quality evidence to support additional interventions such as pain control, type of incision, and use of irrigation, wound cultures, and packing. Although guidelines exist to support clinician management of abscesses, they do not clearly specify these additional interventions. This study sought to describe the ED treatments administered to adults with uncomplicated superficial cutaneous abscesses, defined as purulent lesions requiring incision and drainage that could be managed in an ED or outpatient setting. Methods: Four hundred and seventy-four surveys were distributed to 15 EDs across the United States. Participants were queried about their level of training and practice environment as well as specific questions regarding their management of cutaneous abscesses in the ED. Results: In total, 350 providers responded to the survey (74%). One hundred eighty-nine respondents (54%) were attending physicians, 135 (39%) were residents, and 26 (7%) were midlevel providers. Most providers (76%) used narcotics for pain management, 71% used local anesthetic over the roof of the abscess, and 60% used local anesthetic in a field block for pain control. More than 48% of responders routinely used irrigation after (I&D). Eighty-five percent of responders used a linear incision to drain the abscess and 91% used packing in the wound cavity. Thirty-two percent routinely sent wound cultures and 17% of providers routinely prescribed antibiotics. Most providers (73%) only prescribed antibiotics if certain historical factors or physical findings were present on examination. Antibiotic treatment, if used, favored a combination of 2 or more drugs to cover both Streptococcus and methicillin-resistant Staphylococcus aureus (47%). Follow-up visits were most frequently recommended at 48 hours unless wound was concerning and required closer evaluation. Conclusion: Variability exists in the treatment strategies for abscess care. Most providers used narcotic analgesics in addition to local anesthetic, linear incisions, and packing. Most providers did not irrigate, order wound cultures, or routinely prescribe oral antibiotics unless specific risk factors or physical signs were present. Limited evidence is available at this time to guide these treatment strategies.

Original languageEnglish (US)
Pages (from-to)23-28
Number of pages6
JournalWestern Journal of Emergency Medicine
Volume14
Issue number1
DOIs
StatePublished - Feb 2013
Externally publishedYes

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Emergency Medicine
Abscess
Skin
Hospital Emergency Service
Local Anesthetics
Wounds and Injuries
Anti-Bacterial Agents
Narcotics
Therapeutics
Drainage
Pain
Emergency Treatment
Pain Management
Methicillin-Resistant Staphylococcus aureus
Streptococcus
Outpatients
Guidelines
Physicians
Pharmaceutical Preparations
Surveys and Questionnaires

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

The treatment of cutaneous abscesses : Comparison of emergency medicine providers' practice patterns. / Schmitz, Gillian; Goodwin, Tress; Singer, Adam; Kessler, Chad S.; Bruner, David; Larrabee, Hollynn; May, Larissa S; Luber, Samuel D.; Williams, Justin; Bhat, Rahul.

In: Western Journal of Emergency Medicine, Vol. 14, No. 1, 02.2013, p. 23-28.

Research output: Contribution to journalReview article

Schmitz, G, Goodwin, T, Singer, A, Kessler, CS, Bruner, D, Larrabee, H, May, LS, Luber, SD, Williams, J & Bhat, R 2013, 'The treatment of cutaneous abscesses: Comparison of emergency medicine providers' practice patterns', Western Journal of Emergency Medicine, vol. 14, no. 1, pp. 23-28. https://doi.org/10.5811/westjem.2011.9.6856
Schmitz, Gillian ; Goodwin, Tress ; Singer, Adam ; Kessler, Chad S. ; Bruner, David ; Larrabee, Hollynn ; May, Larissa S ; Luber, Samuel D. ; Williams, Justin ; Bhat, Rahul. / The treatment of cutaneous abscesses : Comparison of emergency medicine providers' practice patterns. In: Western Journal of Emergency Medicine. 2013 ; Vol. 14, No. 1. pp. 23-28.
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abstract = "Introduction: Cutaneous abscesses are commonly treated in the emergency department (ED). Although incision and drainage (I&D) remains the standard treatment, there is little high-quality evidence to support additional interventions such as pain control, type of incision, and use of irrigation, wound cultures, and packing. Although guidelines exist to support clinician management of abscesses, they do not clearly specify these additional interventions. This study sought to describe the ED treatments administered to adults with uncomplicated superficial cutaneous abscesses, defined as purulent lesions requiring incision and drainage that could be managed in an ED or outpatient setting. Methods: Four hundred and seventy-four surveys were distributed to 15 EDs across the United States. Participants were queried about their level of training and practice environment as well as specific questions regarding their management of cutaneous abscesses in the ED. Results: In total, 350 providers responded to the survey (74{\%}). One hundred eighty-nine respondents (54{\%}) were attending physicians, 135 (39{\%}) were residents, and 26 (7{\%}) were midlevel providers. Most providers (76{\%}) used narcotics for pain management, 71{\%} used local anesthetic over the roof of the abscess, and 60{\%} used local anesthetic in a field block for pain control. More than 48{\%} of responders routinely used irrigation after (I&D). Eighty-five percent of responders used a linear incision to drain the abscess and 91{\%} used packing in the wound cavity. Thirty-two percent routinely sent wound cultures and 17{\%} of providers routinely prescribed antibiotics. Most providers (73{\%}) only prescribed antibiotics if certain historical factors or physical findings were present on examination. Antibiotic treatment, if used, favored a combination of 2 or more drugs to cover both Streptococcus and methicillin-resistant Staphylococcus aureus (47{\%}). Follow-up visits were most frequently recommended at 48 hours unless wound was concerning and required closer evaluation. Conclusion: Variability exists in the treatment strategies for abscess care. Most providers used narcotic analgesics in addition to local anesthetic, linear incisions, and packing. Most providers did not irrigate, order wound cultures, or routinely prescribe oral antibiotics unless specific risk factors or physical signs were present. Limited evidence is available at this time to guide these treatment strategies.",
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AU - Schmitz, Gillian

AU - Goodwin, Tress

AU - Singer, Adam

AU - Kessler, Chad S.

AU - Bruner, David

AU - Larrabee, Hollynn

AU - May, Larissa S

AU - Luber, Samuel D.

AU - Williams, Justin

AU - Bhat, Rahul

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N2 - Introduction: Cutaneous abscesses are commonly treated in the emergency department (ED). Although incision and drainage (I&D) remains the standard treatment, there is little high-quality evidence to support additional interventions such as pain control, type of incision, and use of irrigation, wound cultures, and packing. Although guidelines exist to support clinician management of abscesses, they do not clearly specify these additional interventions. This study sought to describe the ED treatments administered to adults with uncomplicated superficial cutaneous abscesses, defined as purulent lesions requiring incision and drainage that could be managed in an ED or outpatient setting. Methods: Four hundred and seventy-four surveys were distributed to 15 EDs across the United States. Participants were queried about their level of training and practice environment as well as specific questions regarding their management of cutaneous abscesses in the ED. Results: In total, 350 providers responded to the survey (74%). One hundred eighty-nine respondents (54%) were attending physicians, 135 (39%) were residents, and 26 (7%) were midlevel providers. Most providers (76%) used narcotics for pain management, 71% used local anesthetic over the roof of the abscess, and 60% used local anesthetic in a field block for pain control. More than 48% of responders routinely used irrigation after (I&D). Eighty-five percent of responders used a linear incision to drain the abscess and 91% used packing in the wound cavity. Thirty-two percent routinely sent wound cultures and 17% of providers routinely prescribed antibiotics. Most providers (73%) only prescribed antibiotics if certain historical factors or physical findings were present on examination. Antibiotic treatment, if used, favored a combination of 2 or more drugs to cover both Streptococcus and methicillin-resistant Staphylococcus aureus (47%). Follow-up visits were most frequently recommended at 48 hours unless wound was concerning and required closer evaluation. Conclusion: Variability exists in the treatment strategies for abscess care. Most providers used narcotic analgesics in addition to local anesthetic, linear incisions, and packing. Most providers did not irrigate, order wound cultures, or routinely prescribe oral antibiotics unless specific risk factors or physical signs were present. Limited evidence is available at this time to guide these treatment strategies.

AB - Introduction: Cutaneous abscesses are commonly treated in the emergency department (ED). Although incision and drainage (I&D) remains the standard treatment, there is little high-quality evidence to support additional interventions such as pain control, type of incision, and use of irrigation, wound cultures, and packing. Although guidelines exist to support clinician management of abscesses, they do not clearly specify these additional interventions. This study sought to describe the ED treatments administered to adults with uncomplicated superficial cutaneous abscesses, defined as purulent lesions requiring incision and drainage that could be managed in an ED or outpatient setting. Methods: Four hundred and seventy-four surveys were distributed to 15 EDs across the United States. Participants were queried about their level of training and practice environment as well as specific questions regarding their management of cutaneous abscesses in the ED. Results: In total, 350 providers responded to the survey (74%). One hundred eighty-nine respondents (54%) were attending physicians, 135 (39%) were residents, and 26 (7%) were midlevel providers. Most providers (76%) used narcotics for pain management, 71% used local anesthetic over the roof of the abscess, and 60% used local anesthetic in a field block for pain control. More than 48% of responders routinely used irrigation after (I&D). Eighty-five percent of responders used a linear incision to drain the abscess and 91% used packing in the wound cavity. Thirty-two percent routinely sent wound cultures and 17% of providers routinely prescribed antibiotics. Most providers (73%) only prescribed antibiotics if certain historical factors or physical findings were present on examination. Antibiotic treatment, if used, favored a combination of 2 or more drugs to cover both Streptococcus and methicillin-resistant Staphylococcus aureus (47%). Follow-up visits were most frequently recommended at 48 hours unless wound was concerning and required closer evaluation. Conclusion: Variability exists in the treatment strategies for abscess care. Most providers used narcotic analgesics in addition to local anesthetic, linear incisions, and packing. Most providers did not irrigate, order wound cultures, or routinely prescribe oral antibiotics unless specific risk factors or physical signs were present. Limited evidence is available at this time to guide these treatment strategies.

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