Emergency Bedside Ultrasound for Pediatric Soft Tissue Infections
Condition: Abscess
MeSH terms: Infections; Abscess; Soft Tissue Infections; Emergencies
Study type: Observational

Summary: 
      The purpose of this study is to determine if soft tissue infections in pediatric patients can
      be more accurately diagnosed (i.e. the presence of a drainable abscess) with the addition of
      bedside ultrasound to the clinical examination compared to the clinical examination alone.
    

Detailed description: 
      Skin and soft tissue infections, particularly abscesses caused by community-acquired
      methicillin resistant Staphylococcus aureus (CA-MRSA) are a growing public health problem.
      The treatment of a skin abscess usually requires incision and drainage or needle aspiration.
      In addition to providing definitive therapy, appropriate drainage can allow for organism
      identification and antibiotic susceptibility testing should antibiotics be utilized. A skin
      cellulitis, which is treated with systemic antibiotics and supportive care alone, may be hard
      to distinguish from an abscess, as both have similar clinical features. Therefore, as the
      presence or absence of purulent material may be difficult to determine, children may undergo
      an unnecessary drainage procedure. If drainage is avoided, the patient may require a
      subsequent ED visit if the diagnosis is missed on initial examination. This can lead to
      worsened clinical outcome, an extra financial burden for the family, and added emotional
      distress for the patient.

      Bedside emergency ultrasound (EUS), which has been used since the mid-1980s is being used in
      adults to detect fluid collections such as soft tissue abscesses. Studies in adult patients
      have shown that EUS adds useful information to the history and physical examination and may
      even alter physicians' clinical impressions and management of patients. Currently, it is not
      known whether children represent a different population for EUS than adults and how EUS would
      perform in the pediatric outpatient setting. With improved diagnosis of soft tissue
      infections, better epidemiologic data about organism prevalence, improved and more prompt
      treatment, and more appropriate use of antibiotic therapy can be done.

      To date, no study exists evaluating its utility specifically for the evaluation of soft
      tissue infections in pediatric patients. The goal of this study is to evaluate the test
      characteristics of EUS in pediatric patients presenting with evidence of soft tissue
      infection.
    

Intervention name(s): Bedside emergency ultrasound
Intervention type(s): Device
Intervention description(s): Ultrasound will be performed on the lesion in question.
Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        Patients will be recruited from the emergency department at a tertiary care children's
        hospital with annual census of 78,000 patients per year.
      
Keywords: Bedside emergency ultrasound; Abscess; Cellulitis; Soft tissue infection; Methicillin resistant staphylococcus aureus (MRSA)