Aller à la navigation principale
Skip notifications
À compter du 1er décembre 2023, l’accès à POEMs et à Essential Evidence Plus ne fera plus partie des avantages offerts aux membres de l’AMC.
Search
Point-of-care ultrasound is useful for ruling out skin and soft tissue abscess
Question clinique
In patients with skin or soft tissue infection, is point-of-care ultrasound effective in differentiating cellulitis from abscess?
L’Essentiel
Point-of-care ultrasound is making its way into more outpatient offices. This meta-analysis of the use of ultrasound by emergency department clinicians to identify skin and soft tissue abscesses found it to be useful to rule out abscess, but less useful to rule it in. 1a
Référence
Plan de l'etude: Meta-analysis (other)
Financement: Self-funded or unfunded
Cadre: Emergency department
Sommaire
These authors searched 7 databases, including Cochrane CENTRAL, along with a clinical trials database and bibliographies of selected studies, to identify 14 studies comprising 2656 total patients. The studies were all randomized controlled trials that evaluated the effectiveness of ultrasound to identify abscess, typically defined as purulence on subsequent incision and debridement. Two authors independently selected studies for inclusion and extracted the data. For diagnosing abscess, ultrasound was 94.6% sensitive (95% CI 89.4% - 97.4%) and 85.4% specific (78.9% - 90.2%), meaning that it was very effective in ruling out abscess but less accurate at ruling it in. Among cases with a high suspicion of abscess (prevalence 65%), ultrasound was slightly more specific (89.1%); among cases that were clinically unclear (prevalence of abscess 52%), ultrasound was similarly accurate in ruling out abscess (91.9% sensitive) but much less reliable in ruling in abscess (76.9% specific). In children, specificity for abscess was also lower (79.9%).
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Commentaires
Ultrasound assessment for possible Abcess
This wound will be very useful for assessing post-op wound erythema
POC US
POC US delays proper surgical treatment with quite some extra / avoidable morbidity !
u/s
useful in the ER, sometimes in the office.
Rule out > rule in???
Bizarre de conclusion. Comment confirmer que les rule outs sont vraiment rule out si on n’incise pas? Ce serait ridicule de inciser toutes les cellulites pour prouver qu’elles ne sont pas des abcès. C’est aussi probablement possible de tenter d’ouvrir un réel abcès a côté de la loculation et en conclure qu’il me s’agissait pas d’abces, surtout si sont très petits. Bref, la conclusion à mon sens doit être que l’échographie est utile pour rule-in l’abcès et justifie d’intervenir chirugicalement. Si doute, alors, le jugement d’ouvrir ou non dois prévaloir en fonction de l’echo et de la clinique.