Pediatric Emergency Medicine, Division of Emergency Medicine, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, MI 48201, USA.
Am J Emerg Med. 2012 Oct;30(8):1347-51. doi: 10.1016/j.ajem.2011.09.020. Epub 2011 Nov 17.
Presentation of skin and soft tissue infections (SSTIs) to the pediatric emergency department (PED) has increased. Physical examination alone can be inadequate in differentiating cellulitis from an abscess. The purposes of this study were to determine the effect of bedside ultrasound (US) in improving diagnostic accuracy for SSTIs in the PED and to evaluate its effect on the management of patients with SSTIs.
We conducted a prospective study of a convenience sample of children who presented to an inner-city PED with signs and symptoms of SSTI. The treating physician's pretest opinions regarding the need for incision and drainage and procedural sedation were collected. A bedside US was performed by trained PED physicians to evaluate for cellulitis vs abscess. The treating physician was made aware of the US findings, and the effect on management was recorded.
Sixty-five patients were enrolled, of whom 47 had US-proven abscess and 18 had cellulitis. The sensitivity of US for detection of abscess was 97.5% (95% confidence interval [CI], 90.1%-99.5%), and the specificity was 69.2% (95% CI, 57.8-72.4%). In comparison, the sensitivity for physical examination alone for detection of abscess was 78.7% (95% CI, 71.4%-84.4%), and the specificity was 66.7% (95% CI, 47.6-81.6%). Ultrasound disagreed with clinical examination and changed management in 9 (13.8%) of 65 patients.
Emergency department bedside US improves accuracy in diagnosis of SSTIs. Bedside US changes management in a small but significant number of patients with SSTIs.
儿科急诊就诊的皮肤和软组织感染（SSTIs）有所增加。仅凭体格检查可能不足以区分蜂窝织炎和脓肿。本研究旨在确定床边超声（US）在提高儿科急诊 SSTI 诊断准确性方面的作用，并评估其对 SSTI 患者管理的影响。
我们对一家市中心儿科急诊就诊的具有 SSTI 体征和症状的便利样本进行了前瞻性研究。收集主治医生关于是否需要切开引流和进行镇静程序的术前意见。经过培训的儿科医生进行床边 US 检查，以评估蜂窝织炎与脓肿。主治医生了解 US 检查结果，并记录对管理的影响。
共纳入 65 例患者，其中 47 例 US 证实为脓肿，18 例为蜂窝织炎。US 检测脓肿的敏感性为 97.5%（95%置信区间[CI]，90.1%-99.5%），特异性为 69.2%（95% CI，57.8%-72.4%）。相比之下，单独体格检查检测脓肿的敏感性为 78.7%（95% CI，71.4%-84.4%），特异性为 66.7%（95% CI，47.6%-81.6%）。US 与临床检查不一致，并改变了 65 例患者中的 9 例（13.8%）的管理。
急诊床边 US 可提高 SSTI 诊断的准确性。床边 US 在一小部分 SSTI 患者中确实改变了管理。
