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- W2069085477 abstract "Study objectives: Soft tissue infections are a common presenting complaint in the emergency department (ED). Cellulitis typically responds well to antibiotic therapy, whereas abscesses must be drained surgically (I+D). We seek to determine the utility of ED bedside ultrasonography in detecting abscesses when added to the physical examination. Methods: This was a prospective, observational convenience sample. All adult patients with a chief complaint suggestive of cellulitis or abscess were eligible for enrollment. Ultrasonography was performed by attending physicians or residents who had received 1 hour of goal-directed training in soft tissue ultrasonography. Before the ultrasonographic examination, the treating physician completed a questionnaire including signs and symptoms, physical examination findings, and a yes/no assessment of whether he or she believed an abscess was present. After completing the bedside ultrasonographic examination, the physician recorded the findings and the revised clinical impression according to ultrasonographic examination. All patients with a pre-ultrasonographic assessment of abscess were incised, regardless of the ultrasonographic findings. The remainder of patients were treated with drainage or antibiotics by physician discretion. Patients who did not have I+D performed were telephoned after 7 days to see whether their skin infection had resolved. Results: From August 2003 to April 2004, 79 patients were enrolled. Of these, 45 patients were diagnosed with abscesses on clinical grounds, confirmed by ultrasonography. Of these, 40 cases were confirmed by I+D. In 2 cases, patients refused the I+D, and in 2 cases, the I+D was negative. One case revealed blood and not pus on the I+D. In 22 cases, clinical impression was negative for abscess, and ultrasonographic examination found no evidence of abscess. On follow-up, 2 patients had a negative I+D, 9 patients healed with antibiotics, 2 were not better after antibiotics, 8 were lost to follow-up, and 1 was diagnosed with an abscess the next day and showed pus on I+D. In 5 cases in which the clinical impression was positive for abscess but the ultrasonographic examination result was negative, 4 patients had negative I+D and 1 left against medical advice. In 7 cases in which the clinical impression was negative for abscess and ultrasonography was positive, 5 patients had a positive I+D, and 2 were discharged without I+D and healed after 2 weeks of antibiotics. Overall, the ultrasonography correctly disagreed with clinical impression in 9 (13%) of 69 confirmed cases. The sensitivity and specificity of ultrasonography to distinguish abscess from cellulitis was 93% and 78%, respectively. Conclusion: Bedside ED ultrasonography may enhance differentiation of abscess from cellulitis." @default.
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- W2069085477 date "2004-10-01" @default.
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- W2069085477 title "ABSCESS: Applied bedside sonography for convenient evaluation of superficial soft tissue infections" @default.
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- W2069085477 doi "https://doi.org/10.1016/j.annemergmed.2004.09.003" @default.
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