Point-of-Care Ultrasound is Associated With Decreased Length of Stay in Children Presenting to the Emergency Department With Soft Tissue Infection

Abstract

Background: Point-of-care ultrasound (POCUS) is increasingly being used to differentiate cellulitis from abscess in the pediatric emergency department (ED). POCUS has also been shown to decrease length of stay (LOS) for other applications among adult patients.

Objective: We sought to determine if ED LOS differed for children presenting with skin and soft tissue infections who received POCUS versus radiology-performed ultrasound.

Methods: We performed a retrospective cohort study of children presenting to an urban pediatric ED between January 2011 and June 2013 with a diagnosis of cellulitis or abscess who underwent soft tissue ultrasound. Patients who received a surgical consult, had significant medical comorbidities, or had a lesion located on the face, hands, feet, or groin were excluded. We compared ED LOS among children who received radiology-performed ultrasound to children who received POCUS, adjusting for relevant clinical variables.

Results: Among 3094 children with a diagnosis of cellulitis or abscess, we identified 202 who underwent a POCUS and 118 who underwent radiology-performed ultrasound. The POCUS group had a shorter median LOS than the radiology-performed ultrasound group (adjusted median difference -73 min; 95% confidence interval -93.6 to -52.4 min). In the subset of patients discharged from the ED, this difference was more pronounced (adjusted median difference -89 min; 95% confidence interval -109.9 to -68.1 min).

Conclusion: Among children presenting to a pediatric ED with superficial skin and soft tissue infections, children receiving POCUS experienced shorter LOS compared to children receiving radiology-performed ultrasound.

Keywords: bedside ultrasound; length of stay; pediatrics; point-of-care ultrasound; soft tissue infection.