Abstract
Background: Superficial soft-tissue infections (SSTI) are frequently managed in the
emergency department (ED). Soft-tissue bedside ultrasound (BUS) for SSTI has not been
specifically studied in the pediatric ED setting. Objective: To evaluate the effect
of a soft-tissue BUS evaluation on the clinical diagnosis and management of pediatric
superficial soft-tissue infection. Methods: We conducted a prospective observational
study in two urban academic pediatric EDs. Eligible patients were aged < 18 years
presenting with suspected SSTI. Before BUS, treating physicians were asked to assess
the likelihood of subcutaneous fluid collection and whether further treatment would
require medical management or invasive management. A trained emergency physician then
performed a BUS of the lesion(s). A post-test questionnaire assessed whether the physician
changed the initial management plan based on the results of the BUS. Results: BUS
changed management in 11/50 cases. After initial clinical assessment, 20 patients
were designated to receive invasive management, whereas the remaining 30 patients
were designated to receive medical management. Management changed in 6/20 in the invasive
group. In the medical group, 5/30 patients changed management. BUS had a sensitivity
of 90% (95% confidence interval [CI] 77–100%) and specificity of 83% (05% CI 70–97%),
whereas clinical suspicion had a sensitivity of 75% (95% CI 56–94%) and specificity
of 80% (95% CI 66–94%) in detecting fluid collections requiring drainage. Conclusions:
BUS evaluation of pediatric SSTI may be a useful clinical adjunct for the emergency
physician. It changed management in 22% of cases by detecting subclinical abscesses
or avoiding unnecessary invasive procedures.
Keywords
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Article info
Publication history
Published online: August 10, 2009
Accepted:
May 22,
2009
Received in revised form:
May 8,
2009
Received:
December 30,
2008
Identification
Copyright
© 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
