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学术急诊医学档案

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  3. 卷 11 编号 1 (2023): Continuous volume
  4. Review Article

卷 11 编号 1 (2023)

八月 2022

Point-Of-Care Ultrasonography for Identification of Skin and Soft Tissue Abscess in Adult and Pediatric Patients; a Systematic Review and Meta-Analysis

  • Erfan Rahmani
  • Ehsan Fayyazishishavan
  • Arian Afzalian
  • Sanaz Varshochi
  • Reza Amani-Beni
  • Seyed-Amirabbas Ahadiat
  • Zeynab Moshtaghi
  • Seyyed-Ghavam Shafagh
  • Roya Khorram
  • Elnaz Asadollahzade
  • Raihaneh Atbaei
  • Mohammad Saeed Kahrizi
  • Atoosa Rahbari
  • Negar Baharlouie
  • Farzaneh Mostanbet
  • Bahamin Amirabadiquchani
  • Moein Kiani
  • Mozhdeh Memarizadeh
  • Shahin Keshtkar Rajabi
  • Reza Barati
  • Hengame Hajinouri
  • Shahrzad Najafi
  • Zeynab Abdollahi
  • Nahid Dadashzadehasl
  • Atousa Moghadam Fard
  • Mozhgan Afshar
  • Atefeh Abedi
  • Sara Saeidi
  • Adeleh Mansourirad
  • Pedram Emami Sharezaei
  • Sepideh Shah Hosseini
  • Zahra Rostami Ghotbabadi
  • Reza Vafadar
  • Roozbeh Roohinezhad
  • Nogol Ghalamkarpour
  • Mehrdad Farrokhi

学术急诊医学档案, 卷 11 编号 1 (2023), 15 八月 2022 , 第 e49 页
https://doi.org/10.22037/aaem.v11i1.2021 已出版: 2023-07-16

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摘要

Introduction: Differentiating the soft tissue abscess from other types of skin and soft tissue infections (SSTIs) poses a particular challenge because they have similar physical evaluation findings, but each disease has a different course, outcome, and treatment. This meta-analysis aimed to investigate the diagnostic accuracy of point-of-care ultrasonography for diagnosis of soft tissue abscess in the emergency departments.

Methods: A comprehensive literature search of MEDLINE, Scopus, Web of Science, Embase, and Google Scholar, from inception to January 2023, was conducted to identify relevant studies investigating the diagnostic performance of point-of-care ultrasonography for identification of abscess. Methodological quality of the included studies was assessed using a revised tool for the quality assessment of diagnostic accuracy studies (QUADAS-2).

Results: The pooled estimates of diagnostic parameters of ultrasonography for diagnosis of abscess were as follows: sensitivity, 0.93 (95% CI: 0.92–0.94); specificity, 0.87 (95% CI: 0.85–0.89), and the area under the summary receiver-operating characteristic (SROC), 0.95. The pooled sensitivity, specificity, and area under the SROC of studies in adult patients were 0.98 (95% CI: 0.92–1), 0.92 (95% CI: 0.86–0.95), and 0.99, respectively. The pooled sensitivity, specificity, and area under the SROC of studies in pediatric patients were 0.9 (95% CI: 0.87–0.92), 0.78 (95% CI: 0.73–0.82), and 0.91, respectively.

Conclusion: Our meta-analysis demonstrated that the point-of-care ultrasonography has excellent diagnostic value for the abscess in the emergency department. Furthermore, we found that the diagnostic performance of point-of-care ultrasonography for diagnosis of abscess was higher for adult cases than for pediatric patients.

关键词:
  • Abscess
  • cellulitis
  • diagnostic imaging
  • meta-analysis
  • ultrasonography
  • pdf (English)

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Rahmani E, Fayyazishishavan E, Afzalian A, Varshochi S, Amani-Beni R, Ahadiat S-A, 等. Point-Of-Care Ultrasonography for Identification of Skin and Soft Tissue Abscess in Adult and Pediatric Patients; a Systematic Review and Meta-Analysis. Arch Acad Emerg Med [网际网络]. 2023年7月16日 [见引于 2026年7月8日];11(1):e49. 载于: https://journals.sbmu.ac.ir/aaem/index.php/AAEM/article/view/2021
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参考

Hersh AL, Chambers HF, Maselli JH, Gonzales R. National trends in ambulatory visits and antibiotic prescribing for skin and soft-tissue infections. Arch Intern Med. 2008;168(14):1585-91.

Ray GT, Suaya JA, Baxter R. Incidence, microbiology, and patient characteristics of skin and soft-tissue infections in a U.S. population: a retrospective population-based study. BMC Infect Dis. 2013;13:252.

Knaysi G, Ringelberg J, Stadlberger N, Soucy Z. Point of Care Ultrasound Use by Associate Providers for Differentiating Abscess Versus Cellulitis Skin and Soft Tissue Infection in the Emergency Department. J Emerg Med. 2021;60(1):e1-e7.

Singer AJ, Talan DA. Management of skin abscesses in the era of methicillin-resistant Staphylococcus aureus. N Engl J Med. 2014;370(11):1039-47.

Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014;59(2):e10-52.

Barbic D, Chenkin J, Cho DD, Jelic T, Scheuermeyer FX. In patients presenting to the emergency department with skin and soft tissue infections what is the diagnostic accuracy of point-of-care ultrasonography for the diagnosis of abscess compared to the current standard of care? A systematic review and meta-analysis. BMJ Open. 2017;7(1):e013688.

Chau CL, Griffith JF. Musculoskeletal infections: ultrasound appearances. Clin Radiol. 2005;60(2):149-59.

Marin JR, Dean AJ, Bilker WB, Panebianco NL, Brown NJ, Alpern ER. Emergency ultrasound-assisted examination of skin and soft tissue infections in the pediatric emergency department. Acad Emerg Med. 2013;20(6):545-53.

Tayal VS, Hasan N, Norton HJ, Tomaszewski CA. The effect of soft-tissue ultrasound on the management of cellulitis in the emergency department. Acad Emerg Med. 2006;13(4):384-8.

Quraishi MS, O'Halpin DR, Blayney AW. Ultrasonography in the evaluation of neck abscesses in children. Clin Otolaryngol Allied Sci. 1997;22(1):30-3.

Levine MC, Arroyo A, Likourezos A, Homel P, Dickman E. The use of point of care ultrasound in the evaluation of pediatric soft tissue neck masses. Am J Emerg Med. 2019;37(8):1466-9.

Adams CM, Neuman MI, Levy JA. Point-of-care ultrasonography for the diagnosis of pediatric soft tissue infection. J Pediatr. 2016;169:122-7. e1.

Lam SH, Sivitz A, Alade K, Doniger SJ, Tessaro MO, Rabiner JE, et al. Comparison of ultrasound guidance vs. clinical assessment alone for management of pediatric skin and soft tissue infections. J Emerg Med. 2018;55(5):693-701.

Gaspari RJ, Sanseverino A, Gleeson T. Abscess incision and drainage with or without ultrasonography: a randomized controlled trial. Ann Emerg Med. 2019;73(1):1-7.

Subramaniam S, Bober J, Chao J, Zehtabchi S. Point‐of‐care ultrasound for diagnosis of abscess in skin and soft tissue infections. Acad Emerg Med. 2016;23(11):1298-306.

Uspal NG, Klein EJ, Tieder JS, Oron AP, Simon TD. Variation in the use of procedural sedation for incision and drainage of skin and soft tissue infection in pediatric emergency departments. Hosp Pediatr. 2015;5(4):185-92.

Uspal NG, Marin JR, Alpern ER, Zorc JJ. Factors associated with the use of procedural sedation during incision and drainage procedures at a children's hospital. Am J Emerg Med. 2013;31(2):302-8.

Alsaawi A, Alrajhi K, Alshehri A, Ababtain A, Alsolamy S. Ultrasonography for the diagnosis of patients with clinically suspected skin and soft tissue infections: a systematic review of the literature. Eur J Emerg Med. 2017;24(3):162-9.

Mower WR, Crisp JG, Krishnadasan A, Moran GJ, Abrahamian FM, Lovecchio F, et al. Effect of initial bedside ultrasonography on emergency department skin and soft tissue infection management. Ann Emerg Med. 2019;74(3):372-80.

Greenlund LJ, Merry SP, Thacher TD, Ward WJ. Primary care management of skin abscesses guided by ultrasound. Am J Med. 2017;130(5):e191-e3.

Berger T, Garrido F, Green J, Lema PC, Gupta J. Bedside ultrasound performed by novices for the detection of abscess in ED patients with soft tissue infections. Am J Emerg Med. 2012;30(8):1569-73.

Iverson K, Haritos D, Thomas R, Kannikeswaran N. The effect of bedside ultrasound on diagnosis and management of soft tissue infections in a pediatric ED. Am J Emerg Med. 2012;30(8):1347-51.

Sivitz AB, Lam SH, Ramirez-Schrempp D, Valente JH, Nagdev AD. Effect of bedside ultrasound on management of pediatric soft-tissue infection. J Emerg Med. 2010;39(5):637-43.

Squire BT, Fox JC, Anderson C. ABSCESS: applied bedside sonography for convenient evaluation of superficial soft tissue infections. Acad Emerg Med. 2005;12(7):601-6.

Page-Wills C, Simon BC, Christy D, Levitt MA. Utility of ultrasonography on emergency department management of suspected cutaneous abscess. Acad Emerg Med. 2000;7(5):493.

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