PDF(Pubmed)
Abstract：
BACKGROUND: We aimed to evaluate the utility of point-of-care ultrasound (POCUS) in the assessment of hand infections that present to the emergency department (ED) and its impact on medical decision making and patient management.
METHODS: We conducted a retrospective review of patients who presented to two urban academic EDs with clinical presentations concerning for skin and soft tissue infections (SSTI) of the hand between December 2015 and December 2021. Two trained POCUS fellowship physicians reviewed an ED POCUS database for POCUS examinations of the hand. We then reviewed patients\' electronic health records (EHR) for demographic characteristics, history, physical examination findings, ED course, additional imaging studies, consultations, impact of POCUS on patient care and final disposition.
RESULTS: We included a total of 50 cases (28 male, 22 female) in the final analysis. The most common presenting symptoms and exam findings were pain (100%), swelling (90%), and erythema (74%). The most common sonographic findings were edema (76%), soft tissue swelling (78%), and fluid surrounding the tendon (57%). POCUS was used in medical decision making 68% of the time (n=34), with the use of POCUS leading to changes in management 38% of the time (n=19). POCUS use led to early antibiotic use (11/19), early consultation (10/19), and led to the performance of a required procedure (8/19). The POCUS diagnosis was consistent with the discharge diagnosis of flexor tenosynovitis 8/12 times, abscess 12/16 times, and cellulitis 14/20 times.
CONCLUSIONS: POCUS is beneficial for evaluating of hand infections that present to the ED and can be used as an important part of medical decision making to expedite patient care.
METHODS: We conducted a retrospective review of patients who presented to two urban academic EDs with clinical presentations concerning for skin and soft tissue infections (SSTI) of the hand between December 2015 and December 2021. Two trained POCUS fellowship physicians reviewed an ED POCUS database for POCUS examinations of the hand. We then reviewed patients\' electronic health records (EHR) for demographic characteristics, history, physical examination findings, ED course, additional imaging studies, consultations, impact of POCUS on patient care and final disposition.
RESULTS: We included a total of 50 cases (28 male, 22 female) in the final analysis. The most common presenting symptoms and exam findings were pain (100%), swelling (90%), and erythema (74%). The most common sonographic findings were edema (76%), soft tissue swelling (78%), and fluid surrounding the tendon (57%). POCUS was used in medical decision making 68% of the time (n=34), with the use of POCUS leading to changes in management 38% of the time (n=19). POCUS use led to early antibiotic use (11/19), early consultation (10/19), and led to the performance of a required procedure (8/19). The POCUS diagnosis was consistent with the discharge diagnosis of flexor tenosynovitis 8/12 times, abscess 12/16 times, and cellulitis 14/20 times.
CONCLUSIONS: POCUS is beneficial for evaluating of hand infections that present to the ED and can be used as an important part of medical decision making to expedite patient care.
摘要：
背景：我们的目的是评估现场护理超声（POCUS）在评估急诊科（ED）出现的手部感染及其对医疗决策和患者管理的影响中的实用性。
方法：我们对2015年12月至2021年12月期间向两名城市学术ED就诊的患者进行了回顾性研究，这些患者的临床表现涉及手部皮肤和软组织感染（SSTI）。两名训练有素的POCUS研究金医师审查了EDPOCUS数据库，以进行手的POCUS检查。然后，我们回顾了患者的电子健康记录（EHR）的人口统计学特征，历史,体检结果,ED课程,额外的成像研究，协商,POCUS对患者护理和最终处置的影响。
结果：我们共纳入50例（28例男性，22名女性）。最常见的症状和检查结果是疼痛（100％），肿胀（90%），和红斑（74%）。最常见的超声检查结果是水肿（76％），软组织肿胀（78%），和肌腱周围的液体(57%)。POCUS用于医疗决策68%的时间(n=34)，与POCUS的使用导致管理38％的时间变化（n=19）。POCUS使用导致早期抗生素使用（11/19），早期咨询(10/19)，并导致了所需程序的执行（8/19）。POCUS诊断与出院诊断屈肌腱鞘炎一致8/12次，脓肿12/16次，和蜂窝织炎14/20倍。
结论：POCUS有助于评估出现在急诊室的手部感染，可作为医疗决策的重要组成部分，以加快患者护理。
方法：我们对2015年12月至2021年12月期间向两名城市学术ED就诊的患者进行了回顾性研究，这些患者的临床表现涉及手部皮肤和软组织感染（SSTI）。两名训练有素的POCUS研究金医师审查了EDPOCUS数据库，以进行手的POCUS检查。然后，我们回顾了患者的电子健康记录（EHR）的人口统计学特征，历史,体检结果,ED课程,额外的成像研究，协商,POCUS对患者护理和最终处置的影响。
结果：我们共纳入50例（28例男性，22名女性）。最常见的症状和检查结果是疼痛（100％），肿胀（90%），和红斑（74%）。最常见的超声检查结果是水肿（76％），软组织肿胀（78%），和肌腱周围的液体(57%)。POCUS用于医疗决策68%的时间(n=34)，与POCUS的使用导致管理38％的时间变化（n=19）。POCUS使用导致早期抗生素使用（11/19），早期咨询(10/19)，并导致了所需程序的执行（8/19）。POCUS诊断与出院诊断屈肌腱鞘炎一致8/12次，脓肿12/16次，和蜂窝织炎14/20倍。
结论：POCUS有助于评估出现在急诊室的手部感染，可作为医疗决策的重要组成部分，以加快患者护理。
