Bedside ultrasound performed by novices for the detection of abscess in ED patients with soft tissue infections

Tony Berger, Francisco Garrido, Jeffrey Green, Penelope Chun Lema, Jay Gupta

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Objective: The objective was to compare bedside ultrasound (US) to clinical examination for the detection of abscess. Methods: This is a 24-month prospective, observational emergency department (ED) study. Adults with suspected nondraining abscess with planned incision and drainage (I&D) are included in the study. Exclusion criteria are spontaneous drainage and perineal, perirectal, or intraoral location. Before I&D, a second ED physician conducts an US and records the presence or absence of findings suggestive of abscess. A positive I&D of the suspected abscess is the criterion standard. The treating practitioner is blinded to the US results. Ultrasound is performed by novice ED physicians. The findings of the US, the prediction of pus from the clinician and the ultrasonographer in 3 strata (low, indeterminate, definite), and the results of the I&D (pus/no pus) are recorded onto data sheets. Measures of association are reported and Fisher's Exact test is used. Results: Forty patients were enrolled. The sensitivity of novice sonographers to predict a positive I&D with US was 0.97 (0.83-1.00), the specificity was 0.67 (0.24-0.94), the positive likelihood ratio was 2.90, the negative likelihood ratio was 0.04, and the area under the receiver operating characteristic curve was 0.85 (0.66-1.00). Clinical examination yielded a sensitivity of 0.76 (0.58-0.89), specificity of 0.83 (0.36-0.99), positive likelihood ratio of 4.50, negative likelihood ratio of 0.29, and area under the receiver operating characteristic curve of 0.75 (0.50-1.00). Conclusion: Novice ED sonographers can identify abscesses with only minimal US training. Identification of abscess on US may change management of cutaneous abscesses.

Original languageEnglish (US)
Pages (from-to)1569-1573
Number of pages5
JournalAmerican Journal of Emergency Medicine
Volume30
Issue number8
DOIs
StatePublished - Oct 2012

Fingerprint

Soft Tissue Infections
Abscess
Hospital Emergency Service
Suppuration
ROC Curve
Drainage
Physicians
Skin

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Bedside ultrasound performed by novices for the detection of abscess in ED patients with soft tissue infections. / Berger, Tony; Garrido, Francisco; Green, Jeffrey; Lema, Penelope Chun; Gupta, Jay.

In: American Journal of Emergency Medicine, Vol. 30, No. 8, 10.2012, p. 1569-1573.

Research output: Contribution to journalArticle

Berger, Tony ; Garrido, Francisco ; Green, Jeffrey ; Lema, Penelope Chun ; Gupta, Jay. / Bedside ultrasound performed by novices for the detection of abscess in ED patients with soft tissue infections. In: American Journal of Emergency Medicine. 2012 ; Vol. 30, No. 8. pp. 1569-1573.
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abstract = "Objective: The objective was to compare bedside ultrasound (US) to clinical examination for the detection of abscess. Methods: This is a 24-month prospective, observational emergency department (ED) study. Adults with suspected nondraining abscess with planned incision and drainage (I&D) are included in the study. Exclusion criteria are spontaneous drainage and perineal, perirectal, or intraoral location. Before I&D, a second ED physician conducts an US and records the presence or absence of findings suggestive of abscess. A positive I&D of the suspected abscess is the criterion standard. The treating practitioner is blinded to the US results. Ultrasound is performed by novice ED physicians. The findings of the US, the prediction of pus from the clinician and the ultrasonographer in 3 strata (low, indeterminate, definite), and the results of the I&D (pus/no pus) are recorded onto data sheets. Measures of association are reported and Fisher's Exact test is used. Results: Forty patients were enrolled. The sensitivity of novice sonographers to predict a positive I&D with US was 0.97 (0.83-1.00), the specificity was 0.67 (0.24-0.94), the positive likelihood ratio was 2.90, the negative likelihood ratio was 0.04, and the area under the receiver operating characteristic curve was 0.85 (0.66-1.00). Clinical examination yielded a sensitivity of 0.76 (0.58-0.89), specificity of 0.83 (0.36-0.99), positive likelihood ratio of 4.50, negative likelihood ratio of 0.29, and area under the receiver operating characteristic curve of 0.75 (0.50-1.00). Conclusion: Novice ED sonographers can identify abscesses with only minimal US training. Identification of abscess on US may change management of cutaneous abscesses.",
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