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
David Barbic, Jordan Chenkin, Dennis D Cho, Tomislav Jelic, and Frank X Scheuermeyer
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5253602/

During my Emergency Medicine rotation, I had seen the treatment of an abscess that had formed in the upper inner thigh of a young diabetic patient. The affected area already had a cavity from which it drained, but there was still a tender and hard surrounding area. The resident I worked with was having difficulty figuring out the extent of the abscess and breaking up any loculations. I could not help but to wonder if there was an easier way to visualize the presence of the abscess underneath. I came across an article titled “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?”. 

This article was a systematic review and meta-analysis. The objective was to determine the accuracy of POCUS in diagnosing abscesses in patients with skin and soft tissue infections, and the setting was held in emergency departments. PubMed, Medline, Embase and Cochrane databases were searched, and 8 articles met the inclusion criteria, and were selected. A total of 747 subjects were included, 3 from adult ED and 5 from pediatric ED. The quality of these articles were rated good to excellent, according to QUADAS (Quality Assessment of Diagnostic Accuracy Studies) tool. They articles included in this study had their estimated sensitivity and specificity values plotted on a graph.It was estimated that POCUS had a 96.2% sensitivity and 82.9% specificity in diagnosing abscesses. There was a positive likelihood ratio of 5.63, and negative likelihood ratio of 0.05. Five studies had looked into whether POCUS findings impacted management of patients, in terms of whether or not to perform drainage. In pediatric patients, the rate of change ranged between 14-27%; while in adult patients, it was between 17-56%.

The findings showed that POCUS was a good tool to use in Emergency Medicine to identify the presence of abscesses. It also is helpful to influence the direction of management for these patients.