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Superficial skin and soft tissue abscess are frequently managed by opening them up with a procedure called "incision and drainage". It is routine practice in the United States to place packing material inside the abscess cavity after opening them up, in order to promote better wound healing and limit abscess recurrence. However, this practice has never been systematically studied or proven to decrease complications or improve healing. Patients with wound packing usually return to the emergency room or practice setting for multiple "wound checks" and dressing/packing changes which lead to missed days from work or school and utilization of healthcare resources. This procedure can often be painful and may even require conscious sedation (and the risks entailed) especially in children. With rates of superficial skin and soft tissue abscesses on the rise, and emergency room resources being stretched, it is important to determine whether packing wounds is necessary or even advantageous to patients.
This study is the first to systematically evaluate the efficacy of wound packing after superficial skin or soft tissue abscess incision and drainage in children. The investigators will be evaluating wound healing, complications, recurrence and pain associated with packing both short and long term. In addition, the investigators will also be evaluating the utility of bedside point-of-care ultrasound use in predicting the presence of pus inside the abscess cavity. This test may be useful to determine whether incision and drainage is necessary for an individual who has a skin infection that is suspicious for an abscess.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| NOPACKING | Placebo Comparator | The comparison group will undergo a routine incision and drainage procedure but will not have packing placed inside the abscess cavity. |
|
| PACKING | Experimental | This group will receive wound packing as per usual protocol |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Wound packing | Procedure | 1/4" non-iodoform packing loosely placed inside abscess cavity. |
| |
| Measure | Description | Time Frame |
|---|---|---|
| Healing (resolution, cosmesis, complications and recurrence) | one month | |
| Ultrasound test characteristics | day one |
| Measure | Description | Time Frame |
|---|---|---|
| Parental/patient satisfaction | one month | |
| Cost-effectiveness | one month |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| New York University / Bellevue Hospital Center | New York | New York | 10016 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 22653459 | Derived | Kessler DO, Krantz A, Mojica M. Randomized trial comparing wound packing to no wound packing following incision and drainage of superficial skin abscesses in the pediatric emergency department. Pediatr Emerg Care. 2012 Jun;28(6):514-7. doi: 10.1097/PEC.0b013e3182587b20. |
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| ID | Term |
|---|---|
| D000038 | Abscess |
| D012874 | Skin Diseases, Infectious |
| D005667 | Furunculosis |
| D002270 | Carbuncle |
| D005499 | Folliculitis |
| D002481 | Cellulitis |
| D014947 | Wounds and Injuries |
| D000072836 | Surgical Wound |
| ID | Term |
|---|---|
| D013492 | Suppuration |
| D007239 | Infections |
| D007249 | Inflammation |
| D010335 | Pathologic Processes |
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| NoPacking |
| Procedure |
This is a routine incision and drainage procedure but without the use of packing. Sterile gauze dressing will be placed over the abscess cavity. |
|
| D013568 |
| Pathological Conditions, Signs and Symptoms |
| D012871 | Skin Diseases |
| D017437 | Skin and Connective Tissue Diseases |
| D013207 | Staphylococcal Skin Infections |
| D013203 | Staphylococcal Infections |
| D016908 | Gram-Positive Bacterial Infections |
| D001424 | Bacterial Infections |
| D001423 | Bacterial Infections and Mycoses |
| D017192 | Skin Diseases, Bacterial |
| D005393 | Fish Diseases |
| D000820 | Animal Diseases |
| D006201 | Hair Diseases |
| D003240 | Connective Tissue Diseases |