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POCUS for Abscess – A Large Meta-Analysis

July 31, 2020

Written by Clay Smith

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Point-of-care ultrasound (POCUS) was accurate in distinguishing cellulitis from abscess.

Why does this matter?
Many studies have been done on POCUS for distinguishing cellulitis from abscess. Some suggest it is nearly perfectly accurate; others – not so much. What if we put all these together? This is the largest meta-analysis we have covered to date on the subject.

Pooled POCUS pus perspective paper = probably productive
This was a meta-analysis of 14 prospective studies using POCUS to determine cellulitis vs abscess in the ED. Overall, POCUS was 95% sensitive, 85% specific; positive likelihood ratio 6.5; negative LR 0.06. Performance wasn’t quite as good in children. Specifically, sensitivity was 99% in adults, 89% in children; 91% specific in adults, 80% in children. Management was changed correctly 10% of the time, incorrectly in 0.7% of cases. This information is believable, as the reference standard in most studies was purulence (or not) on incision and drainage.

Source
Point-of-Care Ultrasonography for the Diagnosis of Skin and Soft Tissue Abscesses: A Systematic Review and Meta-analysis. Ann Emerg Med. 2020 Jul;76(1):67-77. doi: 10.1016/j.annemergmed.2020.01.004. Epub 2020 Feb 17.

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