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Review
. 2023 Jul 16;11(1):e49.
doi: 10.22037/aaem.v11i1.2021. eCollection 2023.

Point-Of-Care Ultrasonography for Identification of Skin and Soft Tissue Abscess in Adult and Pediatric Patients; a Systematic Review and Meta-Analysis

Erfan Rahmani  1 , Ehsan Fayyazishishavan  2 , Arian Afzalian  1 , Sanaz Varshochi  1 , Reza Amani-Beni  3 , Seyed-Amirabbas Ahadiat  4 , Zeynab Moshtaghi  5 , Seyyed-Ghavam Shafagh  6 , Roya Khorram  7 , Elnaz Asadollahzade  8 , Raihaneh Atbaei  9 , Mohammad Saeed Kahrizi  10 , Atoosa Rahbari  11 , Negar Baharlouie  3 , Farzaneh Mostanbet  12 , Bahamin Amirabadiquchani  13 , Moein Kiani  14 , Mozhdeh Memarizadeh  12 , Shahin Keshtkar Rajabi  15 , Reza Barati  6 , Hengame Hajinouri  16 , Shahrzad Najafi  1 , Zeynab Abdollahi  17 , Nahid Dadashzadehasl  18 , Atousa Moghadam Fard  19 , Mozhgan Afshar  20 , Atefeh Abedi  21 , Sara Saeidi  22 , Adeleh Mansourirad  23 , Pedram Emami Shahrezaei  24 , Sepideh Shah Hosseini  6 , Zahra Rostami Ghotbabadi  12 , Reza Vafadar  25 , Roozbeh Roohinezhad  6 , Nogol Ghalamkarpour  26 , Mehrdad Farrokhi  19
Affiliations
Review

Point-Of-Care Ultrasonography for Identification of Skin and Soft Tissue Abscess in Adult and Pediatric Patients; a Systematic Review and Meta-Analysis

Erfan Rahmani et al. Arch Acad Emerg Med. .

Abstract

Introduction: Differentiating the soft tissue abscess from other types of skin and soft tissue infections (SSTIs) poses a particular challenge because they have similar physical evaluation findings, but each disease has a different course, outcome, and treatment. This meta-analysis aimed to investigate the diagnostic accuracy of point-of-care ultrasonography for diagnosis of soft tissue abscess in the emergency departments.

Methods: A comprehensive literature search of MEDLINE, Scopus, Web of Science, Embase, and Google Scholar, from inception to January 2023, was conducted to identify relevant studies investigating the diagnostic performance of point-of-care ultrasonography for identification of abscess. Methodological quality of the included studies was assessed using a revised tool for the quality assessment of diagnostic accuracy studies (QUADAS-2).

Results: The pooled estimates of diagnostic parameters of ultrasonography for diagnosis of abscess were as follows: sensitivity, 0.93 (95% CI: 0.92-0.94); specificity, 0.87 (95% CI: 0.85-0.89), and the area under the summary receiver-operating characteristic (SROC), 0.95. The pooled sensitivity, specificity, and area under the SROC of studies in adult patients were 0.98 (95% CI: 0.92-1), 0.92 (95% CI: 0.86-0.95), and 0.99, respectively. The pooled sensitivity, specificity, and area under the SROC of studies in pediatric patients were 0.9 (95% CI: 0.87-0.92), 0.78 (95% CI: 0.73-0.82), and 0.91, respectively.

Conclusion: Our meta-analysis demonstrated that the point-of-care ultrasonography has excellent diagnostic value for the abscess in the emergency department. Furthermore, we found that the diagnostic performance of point-of-care ultrasonography for diagnosis of abscess was higher for adult cases than for pediatric patients.

Keywords: Abscess; cellulitis; diagnostic imaging; meta-analysis; ultrasonography.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flowchart of the literature search and selection of studies that reported accuracy of point-of-care ultrasonography for diagnosis of abscess
Figure 2
Figure 2
Forest plot of the pooled sensitivity of point-of-care ultrasonography for diagnosis of abscess. CI: confidence interval
Figure 3
Figure 3
Forest plot of the pooled specificity of point-of-care ultrasonography for diagnosis of abscess. CI: confidence interval
Figure 4
Figure 4
Forest plot of the pooled positive likelihood ratio (LR) of point-of-care ultrasonography for diagnosis of abscess. CI: confidence interval
Figure 5
Figure 5
Forest plot of the pooled negative likelihood ratio (LR) of point-of-care ultrasonography for diagnosis of abscess. CI: confidence interval
Figure 6
Figure 6
Forest plot of the diagnostic odds ratio (OR) of point-of-care ultrasonography for diagnosis of abscess. CI: confidence interval
Figure 7
Figure 7
Summary receiver-operating characteristic (SROC) curve of point-of-care ultrasonography for diagnosis of abscess. AUC: area under the curve. SE: standard error
Figure 8
Figure 8
Funnel plot of publication bias on the pooled diagnostic odds ratio of point-of-care ultrasonography for diagnosis of abscess. CI: confidence interval
See this image and copyright information in PMC

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