title: Utility of bedside sonography to distinguish soft tissue abnormalities from joint effusions in the emergency department.
abstract: OBJECTIVE
  The purpose of this study was to determine the utility of bedside sonography to differentiate soft tissue abnormalities from joint effusions.
  
  
  METHODS
  We conducted a retrospective review of emergency department (ED) patients presenting with joint pain, erythema, and swelling who received bedside sonography. The ED sonographic examinations were performed by emergency physician sonologists who were not involved in clinical assessment and management of these patients. The treating physician's opinions regarding the probability of joint effusion and need for aspiration were documented in the sonography log before the sonographic examination was performed. The bedside sonograms of all patients included in this study were also reviewed for accuracy. Descriptive statistics were used to summarize the data.
  
  
  RESULTS
  A total of 54 patients (mean age +/- SD, 41 +/- 18.9 years) were identified over a 1-year period. The symptomatic joints in our study subjects were as follows: knee, 24 of 54 (44%); elbow, 21 of 54 (38%); ankle, 8 of 54 (15%); and metatarsophalangeal joint, 1 of 54 (2%). Twenty-two of 54 patients (40.7%; 95% confidence interval [CI], 27.6%-53.8%) were found to have joint effusions on sonography. Sonography altered management in 35 of 54 patients (65%; 95% CI, 52%-77.5%). Joint aspiration was planned in 39 of 54 cases (72.2%; 95% CI, 60.2%-84.1%) before sonography. After sonography, only 20 of these patients (37%; 95% CI, 24.1%-49.9%) underwent joint aspiration. There was a statistically significant difference in treatment plans after the addition of bedside sonographic results (P < .01).
  
  
  CONCLUSIONS
  Our study suggests that bedside sonography is useful in differentiating joint effusions from soft tissue abnormalities and directing appropriate therapy.
authors.affiliation: Department of Emergency Medicine, Northside Hospital Forsyth, 1200 Northside Forsyth Dr, Cumming, GA 30041-7659 USA.
authors.forename: Srikar
authors.initials: S
authors.lastname: Adhikari
authors.forename: Michael
authors.initials: M
authors.lastname: Blaivas
mesh_terms: D000328:Adult; D016001:Confidence Intervals; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D005122:Exudates and Transudates / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000000981:diagnostic imaging*; D008297:Male; D019095:Point-of-Care Systems; D012189:Retrospective Studies; D018461:Soft Tissue Infections / Q000000981:diagnostic imaging*; D014463:Ultrasonography