Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE 68198-1150, USA.
Am J Emerg Med. 2011 Sep;29(7):790-5. doi: 10.1016/j.ajem.2010.03.005. Epub 2010 May 1.
The purpose of the study was to compare bedside ultrasound (US) and panorex radiography in the diagnosis of a dental abscess in emergency department (ED).
A retrospective review of ED records of adult patients with atraumatic facial pain, swelling, and toothache who received a panorex x-ray and bedside US was performed. Medical records were reviewed for ED evaluation and disposition. Sensitivity and specificity of US and panorex x-ray were calculated to determine the clinical utility of the 2 tests.
A total of 19 patients were identified. No periapical abscess was reported on panorex x-rays in 7 (37%) of 19 patients. Ultrasound agreed with panorex x-rays in 6 (86%) of 7 cases. One case where US disagreed with x-rays was evaluated by dentistry consultants; and incision and drainage were performed, confirming the presence of an abscess. An x-ray diagnosis of periapical abscess was made in 12 (63%) of 19 patients. Ultrasound agreed with panorex x-ray in 10 (83%) of 12 cases. In 1 of the 2 cases where US disagreed with panorex x-rays, x-ray abnormalities were reported on the nonsymptomatic side. The other patient was given antibiotics and recommended outpatient follow-up. Follow-up information was not available to further confirm the presence of an abscess. Assuming that the patient who was lost to follow-up had dental abscess, the sensitivity and specificity of US in diagnosing a dental abscess were 92% and 100%, respectively.
Bedside US is nonionizing, is readily available, and can provide an alternative to panorex x-rays in the evaluation of a dental abscess in ED.
本研究旨在比较床边超声（US）和全景 X 线摄影在急诊科（ED）诊断牙脓肿中的作用。
对接受全景 X 线和床边 US 检查的创伤性面部疼痛、肿胀和牙痛的成年 ED 患者的 ED 记录进行回顾性审查。对医疗记录进行回顾，以评估 ED 的处理。计算 US 和全景 X 射线的敏感性和特异性，以确定两种检查的临床实用性。
共确定 19 名患者。在 19 名患者中，7 名（37%）患者的全景 X 射线未报告根尖脓肿。US 与 7 例中的 6 例（86%）的 X 射线一致。1 例 US 与 X 射线不一致的病例经牙科顾问评估；进行切开引流术，证实存在脓肿。19 名患者中有 12 名（63%）诊断为根尖脓肿。US 与 12 例中的 10 例（83%）的 X 射线一致。在 US 与全景 X 射线不一致的 2 例中，有 1 例在无症状侧报告 X 射线异常。另一名患者给予抗生素并建议门诊随访。没有进一步确认脓肿存在的随访信息。假设失访患者患有牙脓肿，则 US 诊断牙脓肿的敏感性和特异性分别为 92%和 100%。
床边 US 是非电离的，易于获得，可以替代 ED 中全景 X 射线评估牙脓肿。
