Using point-of-care ultrasound: Skin and soft tissue infections

Abstract

Volume 32 • Number 4 • April 2019 In earlier articles, we reviewed the clinical use of pointof-care (POC) ultrasound for examining the lungs, heart, and kidneys. This article focuses on soft-tissue ultrasound, which has been shown to be more accurate in the evaluation of skin and soft-tissue infections than physical examination and can reliably distinguish between cellulitis and abscess.1-7 The use of soft-tissue ultrasound has been shown to change management in a signifi cant number of patients with skin and soft-tissue infections by improving decision-making about the need for procedural drainage and expert consultation.5,6,8,9 Use of POC ultrasound to guide abscess drainage has demonstrated improved patient outcomes when compared with drainage guided by physical examination.10 Additionally, soft-tissue ultrasound has been shown to reduce ED length of stay by an average of 73 minutes for children presenting with skin or soft-tissue infections, compared with those undergoing ultrasound performed in the radiology department.11 Extrapolating these data to the adult patient population seems reasonable, although the literature is lacking. Clinicians can quickly achieve profi ciency in soft-tissue ultrasound. Studies have demonstrated that clinicans can achieve adequate image acquisition and interpretation after a 30-minute training session.1,12 When profi cient, clinicians can obtain soft-tissue ultrasound images rapidly, completing studies in less than 1 minute.12 Ultrasound devices have become significantly more affordable and portable, resulting in their expanded use across many disciplines.13 Cost of the machines varies signifi cantly based on capability and size. Healthcare providers can be reimbursed for medically necessary diagDIAGNOSTIC IMAGING REVIEW