Diagnostic panacea? USS that paeds abscess?? St.Emlyn’s
Most emergency physicians love gadgets. And ultrasound machines are great gadgets. If you’re keeping up with the Emergency Medicine literature, you’d be forgiven for believing that ultrasound is the way to diagnose just about anything in an ED. Even your own fractured nose.
So, when we set out to appraise a recent paper from the American Journal of Emergency Medicine investigating the value of ultrasound for diagnosing skin and soft tissue infections in children at the St. Emlyn’s Journal Club, we were in for a bit of a no brainer. Surely.
Ultrasound is good. And this is a great idea – by using ultrasound we can actually see whether there’s an abscess needing incision and drainage, rather than relying on external look & feel alone. Why would we not use ultrasound?
Well, at the St. Emlyn’s journal club we try to take a dispassionate approach. We systematically appraise papers rather than taking them at face value. And here’s what happened when we appraised this paper at last week’s journal club…
So there we have it. Perhaps ultrasound isn’t the bees knees for skin & soft tissue infection in children. It’s a promising technique. But we need more evidence before we can be sure we’re not that, by using it, we’re not actually going to put children through additional unnecessary interventions without improving outcome.
Having said that, there may still be some ‘early adopters’…
— Rick Body (@richardbody) October 26, 2012
And, either way, we’re definitely in agreement with Chris Nickson in his Ultrasound Training Rant on LITFL about the need to improve USS training in Emergency Medicine.
For some further reading in this area, you can find a tutorial on ultrasound differentiation of cellulitis and abscess here and a fantastic review article in the Journal of Ultrasound in Medicine here