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Management of Skin Abscesses with Ultrasound

Am J Med; ePub 2016 Dec 22; Greenlund, et al

More than half of cases involving outpatient procedural management of skin abscesses by primary care physicians were altered by performing point-of-care ultrasound prior to incision and drainage, and physician confidence in procedure was improved, a recent study found. The estimated size of skin abscesses in 31 consecutive patients was compared by clinical examination with that determined by ultrasound. Researchers found:

  • The clinical exam was inaccurate for size estimation by >0.5 cm in 16 (52%) patients.
  • Ultrasound examination changed the physician decision of whether or not incision and drainage should be performed in 7 (23%) patients and altered technique in 10 (32%) patients.
  • Physician confidence in performing the procedure was improved in 16 (52%) cases.

Citation:

Greenlund LJS, Merry SP, Thacher TD, Ward WJ. Primary care management of skin abscesses guided by ultrasound. [Published online ahead of print December 22, 2016]. Am J Med. doi:10.1016/j.amjmed.2016.11.040.

Commentary:

It is clear that incision and drainage is recommended as treatment for an abscess.1 The clinical challenge of incision and drainage arises when the physician must estimate whether incision will actually result in the release of purulent material, rather than just cutting through areas of cellulitis, as it is not often easy to distinguish between cellulitis and an abscess. This study, albeit on only 31 patients, suggests that use of office-based point-of-care ultrasound changed the decision of whether or not incision and drainage should be performed in almost a quarter of patients and changed the approach in another quarter, altering the approach and informing the physician in half of all patients seen with an abscess. The frequency with which abscesses are seen in primary care may not be enough for a practice to order an ultrasound for this use alone, but if point-of-care ultrasound is available, it appears to be another productive use of this technology. —Neil Skolnik, MD

  1. Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. Clin Infect Dis. 2014;59:e10-e52.

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