title: Effect of bedside ultrasound on management of pediatric soft-tissue infection.
abstract: BACKGROUND
  Superficial soft-tissue infections (SSTI) are frequently managed in the emergency department (ED). Soft-tissue bedside ultrasound (BUS) for SSTI has not been specifically studied in the pediatric ED setting.
  
  
  OBJECTIVE
  To evaluate the effect of a soft-tissue BUS evaluation on the clinical diagnosis and management of pediatric superficial soft-tissue infection.
  
  
  METHODS
  We conducted a prospective observational study in two urban academic pediatric EDs. Eligible patients were aged < 18 years presenting with suspected SSTI. Before BUS, treating physicians were asked to assess the likelihood of subcutaneous fluid collection and whether further treatment would require medical management or invasive management. A trained emergency physician then performed a BUS of the lesion(s). A post-test questionnaire assessed whether the physician changed the initial management plan based on the results of the BUS.
  
  
  RESULTS
  BUS changed management in 11/50 cases. After initial clinical assessment, 20 patients were designated to receive invasive management, whereas the remaining 30 patients were designated to receive medical management. Management changed in 6/20 in the invasive group. In the medical group, 5/30 patients changed management. BUS had a sensitivity of 90% (95% confidence interval [CI] 77-100%) and specificity of 83% (05% CI 70-97%), whereas clinical suspicion had a sensitivity of 75% (95% CI 56-94%) and specificity of 80% (95% CI 66-94%) in detecting fluid collections requiring drainage.
  
  
  CONCLUSIONS
  BUS evaluation of pediatric SSTI may be a useful clinical adjunct for the emergency physician. It changed management in 22% of cases by detecting subclinical abscesses or avoiding unnecessary invasive procedures.
authors: Department of Emergency Medicine, The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.
authors: Adam B
authors: AB
authors: Sivitz
authors: Samuel H F
authors: SH
authors: Lam
authors: Daniela
authors: D
authors: Ramirez-Schrempp
authors: Jonathan H
authors: JH
authors: Valente
authors: Arun D
authors: AD
authors: Nagdev
mesh_terms: D000293:Adolescent; D001900:Boston; D002648:Child; D002675:Child, Preschool; D005260:Female; D006785:Hospitals, University; D006786:Hospitals, Urban; D006801:Humans; D007223:Infant; D008297:Male; D019095:Point-of-Care Systems; D011446:Prospective Studies; D012237:Rhode Island; D012680:Sensitivity and Specificity; D018461:Soft Tissue Infections / Q000000981:diagnostic imaging* / Q000628:therapy*; D014463:Ultrasonography; D055815:Young Adult