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Abscess Size and Depth on Ultrasound and Association with Treatment Failure without Drainage
INTRODUCTION: Skin and soft tissue infections (SSTI) occur along a continuum from cellulitis to abscess. Point-of-care ultrasound (POCUS) is effective in differentiating between these two diagnoses and guiding acute management decisions. Smaller and more superficial abscesses may not require a drain...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Department of Emergency Medicine, University of California, Irvine School of Medicine
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7081847/ https://www.ncbi.nlm.nih.gov/pubmed/32191191 http://dx.doi.org/10.5811/westjem.2019.12.41921 |
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author | Russell, Frances M. Rutz, Matt Rood, L. Ken McGee, Justin Sarmiento, Elisa J. |
author_facet | Russell, Frances M. Rutz, Matt Rood, L. Ken McGee, Justin Sarmiento, Elisa J. |
author_sort | Russell, Frances M. |
collection | PubMed |
description | INTRODUCTION: Skin and soft tissue infections (SSTI) occur along a continuum from cellulitis to abscess. Point-of-care ultrasound (POCUS) is effective in differentiating between these two diagnoses and guiding acute management decisions. Smaller and more superficial abscesses may not require a drainage procedure for cure. The goal of this study was to evaluate the optimal abscess size and depth cut-off for determining when a drainage procedure is necessary. METHODS: We conducted a retrospective study of adult patients with a SSTI who had POCUS performed. Patients were identified through an ultrasound database. We reviewed examinations for the presence, size, and depth of abscess. Medical records were reviewed to determine acute ED management and assess outcomes. The primary outcome evaluated the optimal abscess size and depth when a patient could be safely discharged without a drainage procedure. We defined a treatment failure as a return visit within seven days requiring admission, change in antibiotics, or drainage procedure. RESULTS: A total of 162 patients had an abscess confirmed on POCUS and were discharged from the ED without a drainage procedure. The optimal cut-off to predict treatment failure by receiver operating curve analysis was 1.3 centimeters (cm) in longest dimension with a sensitivity of 85% and specificity of 37% (area under the curve [AUC] 0.60, 95% confidence interval [CI], 0.44–0.76), and 0.4cm in depth with a sensitivity of 85% and specificity of 68% (AUC 0.83, 95% CI, 0.74–93). CONCLUSION: This retrospective data suggests that abscesses greater than 0.4 cm in depth from the skin surface may require a drainage procedure. Those less than 0.4 cm in depth may not require a drainage procedure and may be safely treated with antibiotics alone. Further prospective data is needed to validate these findings and to assess for an optimal size cut-off when a patient with a skin abscess may be discharged without a drainage procedure. |
format | Online Article Text |
id | pubmed-7081847 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Department of Emergency Medicine, University of California, Irvine School of Medicine |
record_format | MEDLINE/PubMed |
spelling | pubmed-70818472020-03-24 Abscess Size and Depth on Ultrasound and Association with Treatment Failure without Drainage Russell, Frances M. Rutz, Matt Rood, L. Ken McGee, Justin Sarmiento, Elisa J. West J Emerg Med Health Outcomes INTRODUCTION: Skin and soft tissue infections (SSTI) occur along a continuum from cellulitis to abscess. Point-of-care ultrasound (POCUS) is effective in differentiating between these two diagnoses and guiding acute management decisions. Smaller and more superficial abscesses may not require a drainage procedure for cure. The goal of this study was to evaluate the optimal abscess size and depth cut-off for determining when a drainage procedure is necessary. METHODS: We conducted a retrospective study of adult patients with a SSTI who had POCUS performed. Patients were identified through an ultrasound database. We reviewed examinations for the presence, size, and depth of abscess. Medical records were reviewed to determine acute ED management and assess outcomes. The primary outcome evaluated the optimal abscess size and depth when a patient could be safely discharged without a drainage procedure. We defined a treatment failure as a return visit within seven days requiring admission, change in antibiotics, or drainage procedure. RESULTS: A total of 162 patients had an abscess confirmed on POCUS and were discharged from the ED without a drainage procedure. The optimal cut-off to predict treatment failure by receiver operating curve analysis was 1.3 centimeters (cm) in longest dimension with a sensitivity of 85% and specificity of 37% (area under the curve [AUC] 0.60, 95% confidence interval [CI], 0.44–0.76), and 0.4cm in depth with a sensitivity of 85% and specificity of 68% (AUC 0.83, 95% CI, 0.74–93). CONCLUSION: This retrospective data suggests that abscesses greater than 0.4 cm in depth from the skin surface may require a drainage procedure. Those less than 0.4 cm in depth may not require a drainage procedure and may be safely treated with antibiotics alone. Further prospective data is needed to validate these findings and to assess for an optimal size cut-off when a patient with a skin abscess may be discharged without a drainage procedure. Department of Emergency Medicine, University of California, Irvine School of Medicine 2020-03 2020-02-26 /pmc/articles/PMC7081847/ /pubmed/32191191 http://dx.doi.org/10.5811/westjem.2019.12.41921 Text en Copyright: © 2020 Russell et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) License. See: http://creativecommons.org/licenses/by/4.0/ |
spellingShingle | Health Outcomes Russell, Frances M. Rutz, Matt Rood, L. Ken McGee, Justin Sarmiento, Elisa J. Abscess Size and Depth on Ultrasound and Association with Treatment Failure without Drainage |
title | Abscess Size and Depth on Ultrasound and Association with Treatment Failure without Drainage |
title_full | Abscess Size and Depth on Ultrasound and Association with Treatment Failure without Drainage |
title_fullStr | Abscess Size and Depth on Ultrasound and Association with Treatment Failure without Drainage |
title_full_unstemmed | Abscess Size and Depth on Ultrasound and Association with Treatment Failure without Drainage |
title_short | Abscess Size and Depth on Ultrasound and Association with Treatment Failure without Drainage |
title_sort | abscess size and depth on ultrasound and association with treatment failure without drainage |
topic | Health Outcomes |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7081847/ https://www.ncbi.nlm.nih.gov/pubmed/32191191 http://dx.doi.org/10.5811/westjem.2019.12.41921 |
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