The effect of bedside ultrasound on diagnosis and management of soft tissue infections in a pediatric ED

Iverson, Katrina; Haritos, Demetris; Thomas, Ronald; Kannikeswaran, Nirupama

doi:10.1016/j.ajem.2011.09.020

Cited by 85 publications

(70 citation statements)

References 10 publications

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“…11 EPs have become more adept at fracture diagnosis through independent review of US and radiographic imaging, and many researchers have examined the ability of EPs to obtain US imaging and diagnose fracture. 12,13 Additionally, bedside US has excellent diagnostic test characteristics when performed by EPs compared to radiologists in the diagnostic evaluation for soft tissue infections, 14 cholecystitis, 15 pneumothorax, 16 or ruling out ectopic pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of History, Physical Examination, and Bedside Ultrasound for Diagnosis of Extremity Fractures in the Emergency Department: A Systematic Review

Joshi

Lira

Mehta

et al. 2013

Academic Emergency Medicine

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Objectives: Understanding history, physical examination, and ultrasonography (US) to diagnose extremity fractures compared with radiography has potential benefits of decreasing radiation exposure, costs, and pain and improving emergency department (ED) resource management and triage time. Methods:The authors performed two electronic searches using PubMed and EMBASE databases for studies published between 1965 to 2012 using a strategy based on the inclusion of any patient presenting with extremity injuries suspicious for fracture who had history and physical examination and a separate search for US performed by an emergency physician (EP) with subsequent radiography. The primary outcome was operating characteristics of ED history, physical examination, and US in diagnosing radiologically proven extremity fractures. The methodologic quality of the studies was assessed using the quality assessment of studies of diagnostic accuracy tool (QUADAS-2).Results: Nine studies met the inclusion criteria for history and physical examination, while eight studies met the inclusion criteria for US. There was significant heterogeneity in the studies that prevented data pooling. Data were organized into subgroups based on anatomic fracture locations, but heterogeneity within the subgroups also prevented data pooling. The prevalence of fracture varied among the studies from 22% to 70%. Upper extremity physical examination tests have positive likelihood ratios (LRs) ranging from 1.2 to infinity and negative LRs ranging from 0 to 0.8. US sensitivities varied between 85% and 100%, specificities varied between 73% and 100%, positive LRs varied between 3.2 and 56.1, and negative LRs varied between 0 and 0.2. Conclusions:Compared with radiography, EP US is an accurate diagnostic test to rule in or rule out extremity fractures. The diagnostic accuracy for history and physical examination are inconclusive. Future research is needed to understand the accuracy of ED US when combined with history and physical examination for upper and lower extremity fractures.ACADEMIC EMERGENCY MEDICINE 2013; 20:1-15 © 2013 by the Society for Academic Emergency Medicine E xtremity injuries are among the most frequent reasons for visiting the emergency department (ED). These injuries are significant, comprising over 42.4 million injury-related visits to the ED in 2006. 1The typical work-up of the injured patient generally involves a medical provider obtaining a history and physical examination, often followed by radiologic imaging. However, many times the radiologic imaging may be negative or inconclusive, which calls to question whether the imaging contributed to the management or outcome of the patient. Studies have shown that often the imaging obtained is unnecessary and results in radiation exposure to patients and increased ED wait times. 2There is a low rate of positive radiography when assessing for fractures as evidenced by a retrospective review by Bentohami et al.,3 in which only 50% of upper extremity x-rays showed fractures, and another ...

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Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of History, Physical Examination, and Bedside Ultrasound for Diagnosis of Extremity Fractures in the Emergency Department: A Systematic Review

Joshi

Lira

Mehta

et al. 2013

Academic Emergency Medicine

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“…Ultrasound is 90-97% sensitive and 67-83% specific in detecting superficial abscesses when performed by point-of-care emergency sonographers [4][5][6]. Further, ultrasound is accessible and does not involve ionizing radiation [7].…”

Section: Is There a Need For Ultrasound?mentioning

confidence: 99%

Scratching the surface

Fenster

Renny

et al. 2015

Current Opinion in Pediatrics

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“…For diagnosing abscesses, ultrasonography is more sensitive (sensitivity, 96.7%; specificity, 85.7%) than computed tomography (CT) (sensitivity, 76.7%; specificity, 91.4%) and is favored as the initial diagnostic imaging test. 22 Bedside ultrasonography can be performed in the emergency department to improve diagnostic accuracy during clinical examination, 23,24 with the advantages of portability, immediate availability, low costs, and increased patient comfort compared with formal ultrasonography. 24 Computed tomography should be reserved for patients in whom the ultrasonographic images are unclear or the abscess extends into deeper tissue.…”

Section: Imagingmentioning

confidence: 99%

Hospitalist Perspective on the Treatment of Skin and Soft Tissue Infections

Amin

Cerceo

Deitelzweig

et al. 2014

Mayo Clinic Proceedings

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The prevalence of skin and soft tissue infections (SSTIs) has been increasing in the United States. These infections are associated with an increase in hospital admissions. Hospitalists play an increasingly important role in the management of these infections and need to use hospital resources efficiently and effectively. When available, observation units are useful for treating low-risk patients who do not require hospital admission. Imaging tools may help to exclude abscesses and necrotizing soft tissue infections; however, surgical exploration remains the principal means of diagnosing necrotizing soft tissue infections. The most common pathogens that cause SSTIs are streptococci and Staphylococcus aureus. Methicillin-resistant S aureus (MRSA) is a prevalent pathogen, and concerns are increasing regarding the unclear distinctions between community-acquired and hospital-acquired MRSA. Other less frequent pathogens that cause SSTIs include Enterococcus species, Escherichia coli, Klebsiella species, Enterobacter species, and Pseudomonas aeruginosa. Cephalexin and clindamycin are suitable options for infections caused by streptococcal species and methicillin-susceptible S aureus. The increasing resistance of S aureus and Streptococcus pyogenes to erythromycin limits its use in these infections, and better alternatives are available. Parenteral cefazolin, nafcillin, or oxacillin can be used in hospitalized patients with nonpurulent cellulitis caused by streptococci and methicillin-susceptible S aureus. When oral MRSA therapy is indicated, clindamycin, doxycycline, trimethoprim-sulfamethoxazole, or linezolid is appropriate. Vancomycin, linezolid, daptomycin, tigecycline, telavancin, and ceftaroline fosamil are intravenous options that should be used in MRSA infections that require patient hospitalization. In the treatment of patients with SSTIs, hospitalists are at the forefront of providing proper patient care that reduces hospital costs, duration of therapy, and therapeutic failures. This review updates guidelines on the management of SSTIs with a focus on infections caused by S aureus, particularly MRSA, and outlines the role of the hospitalist in the effective management of SSTIs.

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The effect of bedside ultrasound on diagnosis and management of soft tissue infections in a pediatric ED

Cited by 85 publications

References 10 publications

Diagnostic Accuracy of History, Physical Examination, and Bedside Ultrasound for Diagnosis of Extremity Fractures in the Emergency Department: A Systematic Review

Diagnostic Accuracy of History, Physical Examination, and Bedside Ultrasound for Diagnosis of Extremity Fractures in the Emergency Department: A Systematic Review

Scratching the surface

Hospitalist Perspective on the Treatment of Skin and Soft Tissue Infections

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