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 language | English (US) |
|---|---|
| Pages (from-to) | 1569-1573 |
| Number of pages | 5 |
| Journal | American Journal of Emergency Medicine |
| Volume | 30 |
| Issue number | 8 |
| DOIs | |
| State | Published - Oct 2012 |
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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 journal › Article
}
TY - JOUR
T1 - Bedside ultrasound performed by novices for the detection of abscess in ED patients with soft tissue infections
AU - Berger, Tony
AU - Garrido, Francisco
AU - Green, Jeffrey
AU - Lema, Penelope Chun
AU - Gupta, Jay
PY - 2012/10
Y1 - 2012/10
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=84869384152&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84869384152&partnerID=8YFLogxK
U2 - 10.1016/j.ajem.2011.08.002
DO - 10.1016/j.ajem.2011.08.002
M3 - Article
VL - 30
SP - 1569
EP - 1573
JO - American Journal of Emergency Medicine
JF - American Journal of Emergency Medicine
SN - 0735-6757
IS - 8
ER -