Primary Care Management of Skin Abscesses Guided by Ultrasound

Area of Science:

• Medical Imaging
• Point-of-Care Ultrasound
• Dermatology

Background:

• Primary care physicians frequently manage skin abscesses.
• Clinical assessment of abscess size, depth, and differentiation from cellulitis is challenging due to tissue induration.
• Accurate assessment is crucial as treatment (incision and drainage) approach depends on abscess characteristics and surrounding anatomy.

Purpose of the Study:

• To compare the accuracy of clinical examination with point-of-care ultrasound (POCUS) in estimating skin abscess size and depth.
• To evaluate the impact of POCUS on physician decision-making and procedural technique for incision and drainage.
• To assess the effect of POCUS on physician confidence in managing skin abscesses.

Main Methods:

• Prospective comparison of clinical examination versus POCUS for 31 primary care outpatient abscess cases.
• POCUS was used to measure abscess dimensions, determine depth, and identify adjacent neurovascular structures before incision and drainage.
• Physicians reported changes in management decisions or techniques based on POCUS findings.

Main Results:

• Clinical examination overestimated or underestimated abscess size by >0.5 cm in 52% of patients.
• POCUS altered the decision to perform incision and drainage in 23% of cases and changed the procedural technique in 32%.
• Overall, POCUS influenced management in 55% of cases and improved physician confidence in 52%.

Conclusions:

• Point-of-care ultrasound significantly impacts the procedural management of skin abscesses in primary care.
• Pre-procedural POCUS enhances diagnostic accuracy and guides surgical approach, improving physician decision-making and confidence.
• Integrating POCUS into outpatient settings offers a valuable tool for optimizing skin abscess treatment.