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Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus MRSA
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Validation of a Clinical Decision Rule for Ultrasound Identification of MRSA Skin Abscesses in Children

Christie M Gutierrez1, Laurie Malia, Lorraine K Ng

  • 1From the Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York-Presbyterian, New York, NY.

Pediatric Emergency Care
|February 2, 2023
PubMed

Insights

This study validated an adult clinical decision rule for identifying methicillin-resistant Staphylococcus aureus (MRSA) skin abscesses in children using ultrasound. The rule showed good sensitivity and negative predictive value, aiding in pediatric MRSA abscess diagnosis.

Area of Science:

  • Pediatric Emergency Medicine
  • Infectious Diseases
  • Medical Imaging

Background:

  • Skin and soft tissue infections are common in children.
  • Methicillin-resistant Staphylococcus aureus (MRSA) is a significant pathogen causing these infections.
  • Accurate identification of MRSA abscesses is crucial for appropriate treatment.

Purpose of the Study:

  • To validate an existing adult-derived clinical decision rule for ultrasound-guided identification of MRSA skin abscesses in a pediatric population.
  • To assess the performance characteristics of this rule in children presenting to the emergency department.

Main Methods:

  • Retrospective study of pediatric patients (<21 years) with skin and soft tissue infections.
  • Ultrasound scans were reviewed by expert pediatric emergency physicians for specific features.
  • Interrater reliability was assessed, and discrepancies were resolved by a third expert.
  • Test performance characteristics of the clinical decision rule were calculated.

Main Results:

  • The study included 209 pediatric patients, with 33% testing positive for MRSA.
  • The clinical decision rule demonstrated a sensitivity of 86% and a negative predictive value of 82%.
  • Specificity was 32%, and positive predictive value was 38%.

Conclusions:

  • The validated clinical decision rule shows moderately high sensitivity and negative predictive value for identifying MRSA abscesses in children.
  • Ultrasound, guided by this rule, can potentially improve antibiotic selection and patient outcomes.
  • The findings support the use of this rule in pediatric emergency settings for MRSA abscess diagnosis.
Abstract

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