Document Detail

Emergency ultrasound-assisted examination of skin and soft tissue infections in the pediatric emergency department.
MedLine Citation:
PMID:  23758300     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The objective was to evaluate the test characteristics of clinical examination (CE) with the addition of bedside emergency ultrasound (CE+EUS) compared to CE alone in determining skin and soft tissue infections (SSTIs) that require drainage in pediatric patients.
METHODS: This was a prospective study of CE+EUS as a diagnostic test for the evaluation of patients 2 months to 19 years of age evaluated for SSTIs in a pediatric emergency department (ED). Two physicians clinically and independently evaluated each lesion, and the reliability of the CE for diagnosing lesions requiring drainage was calculated. Trained pediatric emergency physicians performed US following their CEs. The authors determined and compared the test characteristics for evaluating a SSTI requiring drainage for CE alone and for CE+EUS for those lesions in which the two physicians agreed and were certain regarding their CE diagnosis (clinically evident). The performance of CE+EUS was evaluated in those lesions in which the two physicians either disagreed or were uncertain of their diagnosis (not clinically evident). The reference standard for determining if a lesion required drainage was defined as pus expressed at the time of the ED visit or within 2 days by follow-up assessment.
RESULTS: A total of 387 lesions underwent CE+EUS and were analyzed. CE agreement between physicians was fair (κ = 0.38). For the 228 lesions for which physicians agreed and were certain of their diagnoses, sensitivity was 94.7% for CE and 93.1% for CE+EUS (difference = -1.7%; 95% confidence interval [CI] = -3.4% to 0%). The specificity of CE was 84.2% compared to 81.4% for CE+EUS (difference = -2.8%; 95% CI = -9.7% to 4.1%). For lesions not clinically evident based on CE, the sensitivity of CE was 43.7%, compared with 77.6% for CE+EUS (difference = 33.9%; 95% CI = 1.2% to 66.6%). The specificity of CE for this group was 42.0%, compared with 61.3% for CE+EUS (difference = 19.3%; 95% CI = -13.8% to 52.4%).
CONCLUSIONS: For clinically evident lesions, the addition of ultrasound (US) did not significantly improve the already highly accurate CE for diagnosing lesions requiring drainage in this study population. However, there were many lesions that were not clinically evident, and in these cases, US may improve the accuracy of the CE.
Jennifer R Marin; Anthony J Dean; Warren B Bilker; Nova L Panebianco; Naomi J Brown; Elizabeth R Alpern
Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Academic emergency medicine : official journal of the Society for Academic Emergency Medicine     Volume:  20     ISSN:  1553-2712     ISO Abbreviation:  Acad Emerg Med     Publication Date:  2013 Jun 
Date Detail:
Created Date:  2013-06-13     Completed Date:  2013-10-21     Revised Date:  2014-06-03    
Medline Journal Info:
Nlm Unique ID:  9418450     Medline TA:  Acad Emerg Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  545-53     Citation Subset:  IM    
Copyright Information:
© 2013 by the Society for Academic Emergency Medicine.
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MeSH Terms
Child, Preschool
Emergency Medical Services / methods*
Pediatrics / methods*
Physical Examination*
Point-of-Care Systems
Predictive Value of Tests
Prospective Studies
Skin Diseases, Infectious / ultrasonography*
Soft Tissue Infections / ultrasonography*
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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