Effect of Initial Bedside Ultrasonography on Emergency Department Skin and Soft Tissue Infection Management - 23/08/19
, Jonathan G. Crisp, MD a, b, Anusha Krishnadasan, PhD b, Gregory J. Moran, MD b, Fredrick M. Abrahamian, DO b, Frank Lovecchio, DO, MPH c, David J. Karras, MD d, Mark T. Steele, MD e, Richard E. Rothman, MD, PhD f, David A. Talan, MD bAbstract |
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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| Please see page 373 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Allan B. Wolfson, MD. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: WRM, JGC, AK, GJM, and DAT conceived of the study and developed the design and protocols. GJM and DAT procured funding. AK, GJM, FMA, FL, DJK, MTS, RER, and DAT contributed data for the study. All authors provided critical review and input, and approved the final article. WRM takes responsibility for the paper as a whole. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. Supported by a grant from the National Institute of Allergy and Infectious Diseases (1U01 HHSN272200700032C). |
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| Trial registration number: NCT00729937 |
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Vol 74 - N° 3
P. 372-380 - septembre 2019 Retour au numéro
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