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Ann Emerg Med. 2019 Sep;74(3):372-380. doi: 10.1016/j.annemergmed.2019.02.002. Epub 2019 Mar 27.

Effect of Initial Bedside Ultrasonography on Emergency Department Skin and Soft Tissue Infection Management.

Author information

1
UCLA Department of Emergency Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA. Electronic address: wmower@ucla.edu.
2
UCLA Department of Emergency Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA; Department of Emergency Medicine and Department of Medicine, Division of Infectious Diseases, Olive View-UCLA Medical Center, Sylmar, CA.
3
Department of Emergency Medicine and Department of Medicine, Division of Infectious Diseases, Olive View-UCLA Medical Center, Sylmar, CA.
4
Department of Emergency Medicine, Maricopa Medical Center, University of Arizona and Mayo Graduate School of Medicine, Phoenix, AZ.
5
Department of Emergency Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA.
6
Department of Emergency Medicine, Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City, MO.
7
Department of Emergency Medicine, Johns Hopkins Medical Center, Johns Hopkins School of Medicine, Baltimore, MD.

Abstract

STUDY OBJECTIVE:

We examine the utility of emergency department (ED) ultrasonography in treatment of skin and soft tissue infections.

METHODS:

We enrolled ED patients with skin and soft tissue infections and surveyed clinicians in regard to their pre-ultrasonography certainty about the presence or absence of an abscess, their planned management, post-ultrasonography findings, and actual management. We determined sensitivity and specificity of ultrasonography and clinical evaluation, and assessed appropriateness of management changes based on initial clinical assessment and outcomes through 1-week follow-up.

RESULTS:

Among 1,216 patients, clinicians were uncertain of abscess presence in 105 cases (8.6%) and certain for 1,111 cases (91.4%). Based on surgical exploration and follow-up through 1 week, sensitivity and specificity for abscess detection by clinical evaluation were 90.3% and 97.7%, and by ultrasonography were 94.0% and 94.1%, respectively. Among 1,111 cases for which the clinician was certain, sensitivity and specificity of clinical evaluation were 96.6% and 97.3% compared with ultrasonographic evaluation sensitivity and specificity of 95.7% and 96.2%, respectively. Of 105 uncertain cases, sensitivity and specificity of ultrasonography were 68.5% and 80.4%. Ultrasonography changed management in 13 of 1,111 certain cases (1.2%), appropriately in 10 of 13 (76.9%) and inappropriately in 3 of 13 (23.1%). Of 105 uncertain cases, ultrasonography changed management in 25 (23.8%), appropriately in 21 of 25 (84.0%) and inappropriately in 4 of 25 (16.0%).

CONCLUSION:

Ultrasonography rarely changed management when clinicians were certain about the presence or absence of an abscess. When they were uncertain, ultrasonography changed drainage decisions in approximately one quarter of cases, of which most (84%) were appropriate.

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