title: The effect of bedside ultrasound on diagnosis and management of soft tissue infections in a pediatric ED.
abstract: BACKGROUND
  Presentation of skin and soft tissue infections (SSTIs) to the pediatric emergency department (PED) has increased. Physical examination alone can be inadequate in differentiating cellulitis from an abscess. The purposes of this study were to determine the effect of bedside ultrasound (US) in improving diagnostic accuracy for SSTIs in the PED and to evaluate its effect on the management of patients with SSTIs.
  
  
  METHODS
  We conducted a prospective study of a convenience sample of children who presented to an inner-city PED with signs and symptoms of SSTI. The treating physician's pretest opinions regarding the need for incision and drainage and procedural sedation were collected. A bedside US was performed by trained PED physicians to evaluate for cellulitis vs abscess. The treating physician was made aware of the US findings, and the effect on management was recorded.
  
  
  RESULTS
  Sixty-five patients were enrolled, of whom 47 had US-proven abscess and 18 had cellulitis. The sensitivity of US for detection of abscess was 97.5% (95% confidence interval [CI], 90.1%-99.5%), and the specificity was 69.2% (95% CI, 57.8-72.4%). In comparison, the sensitivity for physical examination alone for detection of abscess was 78.7% (95% CI, 71.4%-84.4%), and the specificity was 66.7% (95% CI, 47.6-81.6%). Ultrasound disagreed with clinical examination and changed management in 9 (13.8%) of 65 patients.
  
  
  CONCLUSIONS
  Emergency department bedside US improves accuracy in diagnosis of SSTIs. Bedside US changes management in a small but significant number of patients with SSTIs.
authors.affiliation: Pediatric Emergency Medicine, Division of Emergency Medicine, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, MI 48201, USA. skierelise@hotmail.com
authors.forename: Katrina
authors.initials: K
authors.lastname: Iverson
authors.forename: Demetris
authors.initials: D
authors.lastname: Haritos
authors.forename: Ronald
authors.initials: R
authors.lastname: Thomas
authors.forename: Nirupama
authors.initials: N
authors.lastname: Kannikeswaran
mesh_terms: D000038:Abscess / Q000175:diagnosis / Q000000981:diagnostic imaging; D000293:Adolescent; D002481:Cellulitis / Q000175:diagnosis / Q000000981:diagnostic imaging; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004322:Drainage; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010808:Physical Examination; D019095:Point-of-Care Systems; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D018461:Soft Tissue Infections / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000628:therapy; D014463:Ultrasonography