Effect of bedside ultrasound on management of pediatric soft-tissue infection.
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.
Sivitz
Adam B
AB
Department of Emergency Medicine, The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.
Lam
Samuel H F
SH
Ramirez-Schrempp
Daniela
D
Valente
Jonathan H
JH
Nagdev
Arun D
AD
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