Bedside ultrasound performed by novices for the detection of abscess in ED patients with soft tissue infections.
OBJECTIVE
The objective was to compare bedside ultrasound (US) to clinical examination for the detection of abscess.


METHODS
This is a 24-month prospective, observational emergency department (ED) study. Adults with suspected nondraining abscess with planned incision and drainage (I&D) are included in the study. Exclusion criteria are spontaneous drainage and perineal, perirectal, or intraoral location. Before I&D, a second ED physician conducts an US and records the presence or absence of findings suggestive of abscess. A positive I&D of the suspected abscess is the criterion standard. The treating practitioner is blinded to the US results. Ultrasound is performed by novice ED physicians. The findings of the US, the prediction of pus from the clinician and the ultrasonographer in 3 strata (low, indeterminate, definite), and the results of the I&D (pus/no pus) are recorded onto data sheets. Measures of association are reported and Fisher's Exact test is used.


RESULTS
Forty patients were enrolled. The sensitivity of novice sonographers to predict a positive I&D with US was 0.97 (0.83-1.00), the specificity was 0.67 (0.24-0.94), the positive likelihood ratio was 2.90, the negative likelihood ratio was 0.04, and the area under the receiver operating characteristic curve was 0.85 (0.66-1.00). Clinical examination yielded a sensitivity of 0.76 (0.58-0.89), specificity of 0.83 (0.36-0.99), positive likelihood ratio of 4.50, negative likelihood ratio of 0.29, and area under the receiver operating characteristic curve of 0.75 (0.50-1.00).


CONCLUSIONS
Novice ED sonographers can identify abscesses with only minimal US training. Identification of abscess on US may change management of cutaneous abscesses.
Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, CA, USA. tony.berger@ucdmc.ucdavis.edu
Tony
T
Berger
Francisco
F
Garrido
Jeffrey
J
Green
Penelope Chun
PC
Lema
Jay
J
Gupta
D000038:Abscess / Q000175:diagnosis / Q000000981:diagnostic imaging*; D000328:Adult; D004636:Emergency Service, Hospital; D006801:Humans; D010808:Physical Examination; D010820:Physicians; D019095:Point-of-Care Systems; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D018461:Soft Tissue Infections / Q000175:diagnosis / Q000000981:diagnostic imaging*; D014463:Ultrasonography