367 Point-of-Care Ultrasound for Evaluation of Peritonsillar Abscess

Abstract

Study Objectives: To determine the diagnostic accuracy of the four standard echocardiography views (parasternal long axis [PLAX], parasternal short axis [PSAX], apical four-chamber [A4CH], and subcostal [SC]) in detecting pericardial effusion. Methods: 120 point-of-care echocardiograms were selected from our echocardiography database; all studies were performed by echocardiographers and interpreted by board certified cardiologists. We selected 60 studies with and 60 without pericardial effusion as determined by the final interpretation with effusions ranging from small to large. The cine loops were de-identified, randomized, and sent to three ultrasound fellowship-trained emergency medicine faculty for review. Reviewers were asked to determine whether an effusion was present and the size of the effusion. Sensitivity, specificity, and accuracy were calculated by comparing the reviewer consensus of each view with the composite cardiology report. Results: Accuracy was high for all views with PLAX and SC achieving 88%, followed by A4C at 87% and PSAX at 83%. Using PSAX as the comparison, there was not a difference in accuracy between PLAX and PSAX (p¼0.20), SC and PSAX (p¼0.18), or A4C and PSAX (p¼0.39). Except for PLAX + PSAX (p¼0.40), each combination of views increased the accuracy compared with PSAX alone: p¼0.010 for PLAX + A4C, p¼0.001 for PLAX + SC, p¼0.026 for PSAX + A4C, p¼0.005 for PSAX + SC, and p¼0.004 for A4C + SC. The combinations of PLAX + SC and A4C + SC resulted in the highest accuracy at 94% while the combined PLAX and PSAX was not superior to a single view. Conclusions: Overall accuracy was high for all views; however, the combination of PLAX + SC and A4C + SC provided the highest accuracy. For the detection of pericardial fluid, providers should consider using a minimum of two views, with at least one of them being the SC view, to improve diagnostic accuracy.

Test characteristics of ultrasound for the diagnosis of peritonsillar abscess: A systematic review and meta‐analysis

“…Table 1 describes the characteristics of the included studies. The studies were published from 1992 to 2021, all were published in English, 17 studies were published as full‐text papers, and one study 23 was published only as an abstract. Of the 18 included studies, one was an RCT, 14 were prospective cohort studies, and three were retrospective cohort studies.…”

“…QUADAS‐2 risk of bias assessment of the included studies. Although a total of 18 studies are included in this systematic review, the study by Kelley 23 was only published as a conference abstract and never as a full‐text manuscript. As such, the authors were unable to assess its quality using QUADAS‐2, so this figure only includes 17 studies.…”

“…32 Figure 2 summarizes the quality assessment using the QUADAS-2 tool. One study 23 was only published as a conference abstract and not as a full-text manuscript, so it could not be assessed using QUADAS-2. All included studies were found to be of high or unclear risk of bias.…”