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• W2983206987 abstract "Over 3 million cases of skin and soft tissue infections (SSTIs) including cellulitis and abscesses are managed in U.S. emergency departments (EDs) each year.1-4 Overlap in presentations of cellulitis and abscess, which require different therapeutic approaches, has prompted increasing research into point-of-care ultrasound (POCUS) to help differentiate the two.2, 5, 6 The systematic review summarized here included prospective cohort studies evaluating POCUS for diagnosis of abscess in ED patients.7 The authors of the systematic review included patients with clinical evidence of SSTI. Reference standards varied, typically including draining purulent discharge, computed tomography scan, or clinical follow-up. There were no restrictions with regard to POCUS machine, transducer, protocol, or clinician background. The primary outcome was diagnostic accuracy for abscess in the ED. The authors identified eight relevant studies (n = 747 patients), with three conducted in adult ED and five in pediatric ED. Calculation of the point estimates for the diagnostic accuracy of POCUS found a sensitivity of 95.5% (95% confidence interval [CI] = 88.9 to 98.3) and specificity of 80.3% (95% CI = 56.4 to 92.7).8 There are important limitations to the validity of these data. First, patients with cellulitis but initially negative POCUS for abscess may develop abscess later, confounding the reported results. Second, the included studies incorporated various criterion standards for abscess diagnosis due to absence of a definitive criterion. Perhaps more importantly, this review included few studies, all with convenience samples, routine contamination between clinicians and sonographers (for both diagnosis and management decisions), and shifting reference standards. These methodologic challenges tend to inflate sensitivity and specificity estimates, a concern highlighted by findings from both the largest study in the systematic review and a larger study published after the review.9, 10 The largest study included in the analysis, comprising 25% of the review's sample size, found that POCUS did not add to the diagnostic posttest probability (and may have lowered both sensitivity and specificity) when clinicians felt confident of the diagnosis before ultrasound (i.e., when pretest probability was high). However, when the pretest probability was low or moderate, ultrasound was found to be helpful in increasing the posttest probability.9 Similarly, a large recent study reported that when clinicians felt certain (>90% of cases) of the diagnosis, ultrasound was unhelpful, while in most uncertain cases it improved accuracy.10 Based on this evidence, the accuracy numbers reported in the systematic review do not appear reliably valid for typical or common POCUS use in SSTI. We believe that the diagnostic accuracy of POCUS is dependent on the pre-test probability of abscess. POCUS does appear, however, to be potentially helpful in identifying abscess in ED patients in cases of diagnostic uncertainty. Therefore, we have assigned a color recommendation of yellow (unclear if benefits), although we recognize that POCUS is helpful in cases with clinical uncertainty after clinical examination." @default.
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• W2983206987 date "2019-11-25" @default.
• W2983206987 modified "2023-09-27" @default.
• W2983206987 title "Accuracy of Point‐of‐care Ultrasound for Diagnosing Soft Tissue Abscess" @default.
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• W2983206987 doi "https://doi.org/10.1111/acem.13881" @default.
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