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Emergency medicine
Research
In patients presenting to the emergency department with skin and soft tissue infections what is the diagnostic accuracy of point-of-care ultrasonography for the diagnosis of abscess compared to the current standard of care? A systematic review and meta-analysis
  1. David Barbic1,
  2. Jordan Chenkin2,
  3. Dennis D Cho2,
  4. Tomislav Jelic3,
  5. Frank X Scheuermeyer1
  1. 1Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  2. 2Division of Emergency Medicine, University of Toronto, Toronto, Ontario, Canada
  3. 3Department of Emergency Medicine, University of South Florida, Tampa, Florida, USA
  1. Correspondence to Dr David Barbic; david.barbic{at}ubc.ca

Abstract

Objectives The primary objective of this systematic review was to determine the accuracy of point-of-care ultrasonography (POCUS) in diagnosing abscess in emergency department (ED) patients with skin and soft tissue infections (SSTI). The secondary objective was the accuracy of POCUS in the paediatric population subgroup.

Setting Prospective studies set in emergency departments.

Participants Emergency department patients (adult and paediatric) presenting with SSTI and suspected abscess.

Primary and secondary outcome measures This systematic review was conducted according to Cochrane Handbook guidelines, and the following databases were searched: PubMed, MEDLINE, EMBASE and the Cochrane database of systematic reviews (1946–2015). We included prospective cohort and case–control studies investigating ED patients with SSTI and abscess or cellulitis, a defined POCUS protocol, a clearly defined gold standard for abscess and a contingency table describing sensitivity and specificity. Two reviewers independently ascertained all potentially relevant citations for methodologic quality according to QUADAS-2 criteria. The primary outcome measure was the sensitivity and specificity of POCUS for abscess. A preplanned subgroup (secondary) analysis examined the effects in paediatric populations, and changes in management were explored post hoc.

Results Of 3028 articles, 8 were identified meeting inclusion criteria; all were rated as good to excellent according to QUADAS-2 criteria. Combined test characteristics of POCUS on the ED diagnosis of abscess for patients with SSTI were as follows: sensitivity 96.2% (95% CI 91.1% to 98.4%), specificity 82.9% (95% CI 60.4% to 93.9%), positive likelihood ratio 5.63 (95% CI 2.2 to 14.6) and negative likelihood ratio 0.05 (95% CI 0.01 to 0.11).

Conclusions A total of 8 studies of good-to-excellent quality were included in this review. The use of POCUS helps differentiate abscess from cellulitis in ED patients with SSTI.

Trial registration number CRD42015017115.

  • ACCIDENT & EMERGENCY MEDICINE
  • INFECTIOUS DISEASES

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2016-013688

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    Footnotes

    • Twitter Follow David Barbic at @DavidBarbic and Dennis Cho at @dennischo

    • Contributors DB and DDC conceived the study. DB, DDC, JC and TJ developed the protocol, and DB built the search strategy with a health sciences librarian. DDC and TJ screened citation titles; JC and FXS screened abstracts and full texts. DB and DDC conducted the analysis, and all authors made significant contributions to the draft and final versions of the manuscript.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.