Journal article
Effect of Initial Bedside Ultrasonography on Emergency Department Skin and Soft Tissue Infection Management
Annals of emergency medicine, Vol.74(3), pp.372-380
09/2019
DOI: 10.1016/j.annemergmed.2019.02.002
PMID: 30926187
Abstract
We examine the utility of emergency department (ED) ultrasonography in treatment of skin and soft tissue infections.
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.
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%).
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.
Details
- Title: Subtitle
- Effect of Initial Bedside Ultrasonography on Emergency Department Skin and Soft Tissue Infection Management
- Creators
- William R Mower - Ronald Reagan UCLA Medical CenterJonathan G Crisp - Ronald Reagan UCLA Medical CenterAnusha Krishnadasan - Olive View-UCLA Medical CenterGregory J Moran - Olive View-UCLA Medical CenterFredrick M Abrahamian - Olive View-UCLA Medical CenterFrank Lovecchio - Maricopa Medical CenterDavid J Karras - Temple UniversityMark T Steele - Truman Medical CenterRichard E Rothman - Johns Hopkins UniversityDavid A Talan - Olive View-UCLA Medical Center
- Resource Type
- Journal article
- Publication Details
- Annals of emergency medicine, Vol.74(3), pp.372-380
- DOI
- 10.1016/j.annemergmed.2019.02.002
- PMID
- 30926187
- ISSN
- 0196-0644
- eISSN
- 1097-6760
- Grant note
- DOI: 10.13039/100000060, name: National Institute of Allergy and Infectious Diseases, award: 1U01 HHSN272200700032C
- Language
- English
- Date published
- 09/2019
- Academic Unit
- Emergency Medicine; Internal Medicine
- Record Identifier
- 9984296979302771
Metrics
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