US-Guided Drainage for Pediatric Soft Tissue Abscess

Thomas Pham, MS4

The Article:

Gaspari RJ, Sanseverino A. Ultrasound-Guided Drainage for Pediatric Soft Tissue Abscesses Decreases Clinical Failure Rates Compared to Drainage Without Ultrasound: A Retrospective Study. J Ultrasound Med. 2018;37(1):131-136.

The Idea:

To compare clinical outcomes in pediatric patients presenting to the ED with a possible skin abscess with and without clinician-performed US examinations.

The Study:

A multicenter retrospective observational review of pediatric patients presenting to the ED with an uncomplicated skin and soft tissue abscess from February 2014 to December 2015. Patients were identified for inclusion in this study as those patients presenting to the ED with a suspected skin abscess. Patients aged 0 to 17 years were eligible for inclusion. Patients were excluded if they presented with postsurgical infection, a foreign body, an animal bite, paronychia, a dental abscess, a genital abscess, or a peri-tonsillar abscess. Patients who were clinically ill at presentation (defined as fever, hypotension, or described as “appearing clinically ill”) were also excluded. The primary outcome was therapeutic failure of the treatment regimen, comparing US and non-US. The secondary analysis was failure rates after nonsurgical therapy compared to surgical intervention. Clinical failure was defined as any I&D or surgical manipulation after discharge from the initial ED visit if it produced additional purulence.

The Findings:

Failure rates for patients evaluated with US were significantly lower than those evaluated without US.  Patients with an abscess who had a US examination during their ED visit failed therapy 4.4%of the time (5 of 113) compared to a 15.6% failure rate (29 of 186) when US was not used. Nonsurgical management for patients with an abscess showed improved outcomes when US was used (7.7% versus 29.2%). Failure after I&D was associated with a smaller cavity (17.2 versus 44.8 mm3).  Failure after nonsurgical management was not associated with size or US features.

The Takeaway:

Ultrasound should be incorporated into the care of pediatric patients with suspected skin and soft tissue abscesses and should be used in all cases of suspected abscesses.