对于因皮肤和软组织感染就诊于急诊科的患者，与当前的标准治疗方法相比，即时超声检查诊断脓肿的诊断准确性如何？一项系统评价和荟萃分析。
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.
作者信息
Barbic David, Chenkin Jordan, Cho Dennis D, Jelic Tomislav, Scheuermeyer Frank X
机构信息
Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Division of Emergency Medicine, University of Toronto, Toronto, Ontario, Canada.
出版信息
BMJ Open. 2017 Jan 10;7(1):e013688. doi: 10.1136/bmjopen-2016-013688.
OBJECTIVES
The primary objective of this systematic review was to determine the accuracy of point-of-care ultrasonography (POCUS) in diagnosing abscess in emergency department (ED) patients with skin and soft tissue infections (SSTI). The secondary objective was the accuracy of POCUS in the paediatric population subgroup.
SETTING
Prospective studies set in emergency departments.
PARTICIPANTS
Emergency department patients (adult and paediatric) presenting with SSTI and suspected abscess.
PRIMARY AND SECONDARY OUTCOME MEASURES
This systematic review was conducted according to Cochrane Handbook guidelines, and the following databases were searched: PubMed, MEDLINE, EMBASE and the Cochrane database of systematic reviews (1946-2015). We included prospective cohort and case-control studies investigating ED patients with SSTI and abscess or cellulitis, a defined POCUS protocol, a clearly defined gold standard for abscess and a contingency table describing sensitivity and specificity. Two reviewers independently ascertained all potentially relevant citations for methodologic quality according to QUADAS-2 criteria. The primary outcome measure was the sensitivity and specificity of POCUS for abscess. A preplanned subgroup (secondary) analysis examined the effects in paediatric populations, and changes in management were explored post hoc.
RESULTS
Of 3028 articles, 8 were identified meeting inclusion criteria; all were rated as good to excellent according to QUADAS-2 criteria. Combined test characteristics of POCUS on the ED diagnosis of abscess for patients with SSTI were as follows: sensitivity 96.2% (95% CI 91.1% to 98.4%), specificity 82.9% (95% CI 60.4% to 93.9%), positive likelihood ratio 5.63 (95% CI 2.2 to 14.6) and negative likelihood ratio 0.05 (95% CI 0.01 to 0.11).
CONCLUSIONS
A total of 8 studies of good-to-excellent quality were included in this review. The use of POCUS helps differentiate abscess from cellulitis in ED patients with SSTI.
TRIAL REGISTRATION NUMBER
CRD42015017115.
目的
本系统评价的主要目的是确定床旁超声检查（POCUS）在诊断急诊科（ED）皮肤和软组织感染（SSTI）患者脓肿方面的准确性。次要目的是POCUS在儿科人群亚组中的准确性。
设置
在急诊科开展的前瞻性研究。
参与者
出现SSTI且疑似脓肿的急诊科患者（成人和儿童）。
主要和次要结局指标
本系统评价按照Cochrane手册指南进行，检索了以下数据库：PubMed、MEDLINE、EMBASE和Cochrane系统评价数据库（1946 - 2015年）。我们纳入了调查ED中SSTI和脓肿或蜂窝织炎患者的前瞻性队列研究和病例对照研究、明确的POCUS方案、明确界定的脓肿金标准以及描述敏感性和特异性的列联表。两名评价者根据QUADAS - 2标准独立确定所有潜在相关文献的方法学质量。主要结局指标是POCUS诊断脓肿的敏感性和特异性。一项预先计划的亚组（次要）分析研究了儿科人群中的影响，并在事后探讨了管理方面的变化。
结果
在3028篇文章中，确定有8篇符合纳入标准；根据QUADAS - 2标准，所有文章的质量评级均为良好至优秀。POCUS对SSTI患者急诊科脓肿诊断的综合检验特征如下：敏感性96.2%（95%CI 91.1%至98.4%），特异性82.9%（95%CI 60.4%至93.9%），阳性似然比5.63（95%CI 2.2至14.6），阴性似然比0.05（95%CI 0.01至0.11）。
结论
本评价共纳入8项质量良好至优秀的研究。POCUS的应用有助于在ED的SSTI患者中区分脓肿和蜂窝织炎。
试验注册号
CRD42015017115。
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