Role of point-of-care ultrasound (POCUS) in the diagnosis of an abscess in paediatric skin and soft tissue infections: a systematic review and meta-analysis

Abstract

Aims: To evaluate the effect of point-of-care ultrasound (POCUS) for the diagnosis of an abscess and to compare the diagnostic accuracy of POCUS and physical examination (PE) in paediatric patients with skin and soft tissue infections (SSTI) in the emergency department.Material and methods: A comprehensive literature search was carried out to identify Englishlanguage studies on POCUS for differentiating an abscess from cellulitis in paediatric patients with SSTI. The quality of the study was assessed by the Quality Assessment of Diagnostic Accuracy Studies 2 tool, and pooled sensitivity and specificity of various POCUS findings were determined.Results: Seven studies with a total of 870 patients were included. There was significant heterogeneity across the included studies. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio for the diagnosis of abscess by POCUS were 0.90 (95% confidence interval [CI], 0.82-0.95), 0.80 (95% CI, 0.72-0.86), 4.5 (95% CI, 3.1-6.4), 0.13 (95% CI, 0.07-0.23), and 36 (95% CI, 17-75), respectively, with an area under the curve (AUC) was 0.89 (95% CI, 0.86-0.91). Four studies provided data regarding the PE method. The pooled sensitivity, specificity, and AUC of PE for the abscess were 0.84 (95% CI, 0.80-0.88), 0.69 (95% CI, 0.62-0.76), and 0.85 (95% CI, 0.81-0.88).Conclusions: POCUS is useful in identifying abscesses in paediatric patients with SSTI in emergency department, especially when PE is equivocal and outperforms PE alone.

Bedside ultrasound to detect bone flap infections: A case image

“…Bedside ultrasound has been described as a helpful tool to identify skin and soft tissue infections as a complement to the physical examination and as an aid for further drainage if required 3 . We believe that the same rationale used to identify SSTI can be used to diagnose bone flap infections; the features typically including an anechoic mass with posterior acoustic enhancement, varying degrees of internal echoes and an accompanying swirling (most visible with compression or passive movement), suggestive of fibrin deposition/organization 4 . Ultrasound is a readily available and inexpensive technique, it may obviate the need for the use of potentially deleterious ionizing radiation and simultaneously permit point‐of‐service image‐guided aspiration and diagnosis.…”

“…3 We believe that the same rationale used to identify SSTI can be used to diagnose bone flap infections; the features typically including an anechoic mass with posterior acoustic enhancement, varying degrees of internal echoes and an accompanying swirling (most visible with compression or passive movement), suggestive of fibrin deposition/organization. 4 Ultrasound is a readily available and inexpensive technique, it may obviate the need for the use of potentially deleterious ionizing radiation and simultaneously permit pointof-service image-guided aspiration and diagnosis. This case illustrates the feasibility and the role of bedside ultrasound as a tool to quickly evaluate and identify bone flap pouch infections.…”

How to manage skin and soft-tissue infections in the emergency department

“…The effect and impact of point-of-care ultrasound (POCUS) in the diagnosis of abscesses have been evaluated in a recent meta-analysis. POCUS was helpful in identifying abscesses in patients with SSTI in the emergency department, mainly when the physical examination is unclear and inconclusive [82 ▪ ].…”

Current international and national guidelines for managing skin and soft tissue infections

“…The guidelines of the Surgical Infection Society, in particular, do recommend that ultrasound techniques be performed [4 ▪▪ ]. Point-of-care ultrasonography has good diagnostic accuracy for differentiating abscesses from cellulitis and led to a correct change in management in up to 10% of cases [23 ▪ ,24 ▪ ,25].…”