CanadiEM - By Justin Hsu - May 6, 2021
“Superficial soft tissue infections are a common ED presentation. Cellulitis appears as an area of erythema, edema and tenderness. An abscess is suspected when a discrete fluctuant mass is palpated within the infected tissue. However, relying on these features can be problematic as there is often overlap. Accurately determining the presence or absence of an associated abscess has significant treatment implications. Cellulitis can be medically managed with antibiotics while an abscess generally requires an incision and drainage (I&D). Misdiagnosing one as the other can lead to delay of the appropriate care and worsen the infection. Unfortunately, the physical exam alone, is inadequate to differentiate between the two diagnoses. Berger et al. in 2012 found that clinical exam was only 76% sensitive and 83% specific in detecting an abscess. Yikes. Prior observational studies suggest that bedside ultrasound has high diagnostic accuracy in distinguishing between the two presentations and can reduce the risk of treatment failure...
The accuracy of POCUS to differentiate between cellulitis and abscess is far superior compared to physical exam alone.So bring out the ultrasound machine for your next patient with soft tissue infection so we can continue to provide better and safer patient care.”