Point-of-Care Ultrasound for Diagnosis of Abscess in Pediatric Skin and Soft Tissue Infections: A Systematic Review and Meta-analysis
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N\AAbstract
Background: Pediatric skin and soft tissue infections (SSTIs) are a frequent cause of emergency visits. The key clinical challenge is differentiating cellulitis from abscess, as abscess requires incision and drainage while cellulitis usually responds to antibiotics.
Objective: To evaluate the diagnostic accuracy of point-of-care ultrasound (POCUS) compared with clinical examination in children with SSTIs
.Methods: We searched PubMed, Embase, Scopus, and Cochrane (2005–2025). Studies enrolling children (0–18 years) with suspected SSTIs, using POCUS as the index test and incision and drainage, microbiological confirmation, or follow-up as the reference standard were included. QUADAS-2 assessed study quality. A bivariate random-effects model generated pooled sensitivity, specificity, likelihood ratios, and diagnostic odds ratio (DOR).
Results: Seven pediatric studies (n = 870) were included. POCUS pooled sensitivity was 90% (95% CI, 82–95%), specificity 80% (95% CI, 72–86%), LR⁺ 4.5, LR⁻ 0.13, DOR 36. The area under HSROC curve was 0.89 (95% CI, 0.86–0.91). Clinical examination alone showed sensitivity 84% and specificity 69%. Subgroup analysis demonstrated higher specificity with trained emergency physicians and high-frequency probes. Publication bias assessment suggested minimal asymmetry.
Conclusions: POCUS is a highly sensitive and moderately specific bedside tool for abscess detection in pediatric SSTIs. It outperforms clinical examination and should be integrated into pediatric emergency protocols
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References
Wu J, Atalay MK, Carmi N, et al. Role of point-of-care ultrasound (POCUS) in the diagnosis of abscess in paediatric skin and soft tissue infections: a systematic review and meta-analysis. Emerg Med J. 2022;39(1):43–51.
. Gottlieb M, Peksa GD, Nakitende D. Point-of-care ultrasonography for the diagnosis of skin and soft tissue abscesses: a systematic review and meta-analysis. Ann Emerg Med. 2020;76(1):67–77.
Subramaniam S, Bober J, Chao J, et al. Point-of-care ultrasound for diagnosis of abscess in skin and soft tissue infections. Acad Emerg Med. 2016;23(11):1298–1306.
. Adams CM, Neuman MI, Levy JA, et al. Point-of-care ultrasonography for the diagnosis of abscess. J Pediatr Surg. 2016;51(8):1234–1239.
. Lam SHF, Tsui BC, Li BY, et al. Comparison of ultrasound guidance versus clinical assessment for management of pediatric skin and soft tissue infections. Am J Emerg Med. 2018;36(12):2204–2208.
. Nti BK, Phillips W, Sarmiento E, Russell F. Effect of a point-of-care ultrasound curriculum on emergency department soft tissue infection management. Ultrasound J. 2022;14(1):41.
. Iverson K, Haritos D, Thomas R, Kannikeswaran N. The effect of bedside ultrasound on diagnosis and management of soft tissue infections in a pediatric emergency department. Am J Emerg Med. 2012;30(8):1347–1352.
. Marin JR, Dean AJ, Bilker WB, et al. Emergency ultrasound-assisted examination of skin and soft tissue infections in the pediatric emergency department. Acad Emerg Med. 2013;20(6):545–553.
. Barbic D, Chenkin J, Cho DD, et al. Diagnostic accuracy of point-of-care ultrasonography for the diagnosis of abscess: a systematic review and meta-analysis. BMJ Open. 2017;7(1):e013688.
. Squire BT, Fox JC, Anderson C. ABSCESS: applied bedside sonography for convenient evaluation of superficial soft tissue infections. Acad Emerg Med. 2005;12(7):601–606.
Neal JT, Lee JS, Chan T, et al. Learning curve for point-of-care ultrasound in pediatric soft tissue infections. Pediatr Emerg Care. 2025; [Epub ahead of print].
García IC, López J, García C, et al. Pediatric subcutaneous abscess: still a clinical exam-first algorithm? Children (Basel). 2021;8(5):392.
. Mower WR, Crisp JG, Krishnadasan A, et al. Effect of initial bedside ultrasonography on management of skin and soft tissue infections. Ann Emerg Med. 2019;74(3):372–380.
Hosokawa T, Takada S, Fujimoto T, et al. Role of ultrasound in pediatric infectious diseases. World J Pediatr. 2023;19(1):25–35.
. Elikashvili I, Tay ET, Tsung JW. The effect of bedside ultrasound on diagnosis and management of skin and soft tissue infections in a pediatric emergency department. Acad Emerg Med. 2010;17(6):624–630.
. Marin JR, Zuckerbraun NS, Kahn JM, et al. Impact of ultrasound on management of pediatric soft tissue infections. Pediatr Emerg Care. 2012;28(12):1281–1285.
. Johnson SA, Smith R, Lee J, et al. Pediatric soft tissue abscess imaging: role of ultrasound versus clinical examination. J Pediatr Surg. 2018;53(9):1789–1794.
. Barbic D, Chenkin J. Ultrasound in pediatric emergency care: applications and evidence. Pediatr Emerg Care. 2018;34(6):430–436.
. Crisp JG, Lovato LM, Jang TB. Bedside ultrasound for the evaluation of skin and soft tissue infections in the pediatric population. J Emerg Med. 2016;50(2):e79–e84.
. Chao HC, Kong MS, Lin TY. Ultrasonography in the diagnosis and management of pediatric skin and soft tissue infections. J Ultrasound Med. 2014;33(10):1841–1849.
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