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Differentiate Between Angioedema From Cellulitis in Pediatric Patients With Periorbital Swelling on Point-of-Care
Ee Tein Tay1, James W Tsung2, Yue Jay Lin2
1Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York, USA.
Insights
Point-of-care ultrasound (POCUS) effectively differentiates angioedema from cellulitis in pediatric patients with periorbital swelling. This imaging tool helps reduce unnecessary hospital admissions and further diagnostic tests.
Area of Science:
- Pediatric Emergency Medicine
- Diagnostic Imaging
- Dermatology
Background:
- Periorbital swelling in children often results from insect bites.
- Differentiating between angioedema and cellulitis is crucial for appropriate management.
- Current diagnostic methods may lead to unnecessary interventions.
Purpose of the Study:
- To evaluate the utility of point-of-care ultrasound (POCUS) in distinguishing angioedema from cellulitis in pediatric patients.
- To assess the impact of POCUS on diagnostic accuracy and treatment decisions.
- To determine if POCUS can reduce the need for further imaging and hospital admissions.
Main Methods:
- A subanalysis of pediatric patients (<21 years) presenting to the emergency department with periorbital swelling due to suspected insect bites.
- Physicians received training in soft tissue ultrasound techniques.
- Data collected included pre- and post-POCUS diagnoses, findings, disposition, and treatment.
Main Results:
- Twenty-three pediatric subjects were enrolled.
- Pre-POCUS diagnoses were predominantly allergic skin reactions (86.9%).
- Post-POCUS, diagnoses and management were altered in 5 (21.7%) patients, with ultrasound identifying features suggestive of angioedema in 22 cases.
- No patients required further imaging or hospitalization.
Conclusions:
- Point-of-care ultrasound (POCUS) can be a valuable adjunct tool for differentiating pediatric angioedema from cellulitis.
- POCUS may help decrease unnecessary imaging studies and hospital admissions for periorbital swelling.
- Early and accurate diagnosis using POCUS improves patient management in the emergency department.
Purpose:
This study evaluated the use of point-of-care (POCUS) to differentiate between angioedema and cellulitis in pediatric patients who presented to the emergency department (ED) with periorbital swelling from suspected insect bites.
Methods:
Subanalysis of patients under 21 years old with periorbital swelling from suspected insect bites was performed in patients presenting to the ED. Participating physicians received hands-on soft tissue ultrasound training prior to study enrollment. Pre- and post-POCUS diagnoses and findings, disposition, ED discharge diagnosis, additional imaging studies, and treatment medications were recorded. Patients received telephone follow-up 1 week after the visit.
Results:
Twenty-three subjects were enrolled. Twenty (86.9%) cases had a pre-POCUS diagnosis of allergic skin reaction, one (4.3%) had cellulitis, and two (8.7%) were undetermined. After POCUS, providers changed diagnoses and treatment management on five (21.7%) patients. Ultrasound features of linear bands were identified in 22 ultrasound images suggesting angioedema. No patients received further imaging or were admitted for hospitalization.
Conclusions:
POCUS may serve as an adjunct tool in differentiating between cellulitis and angioedema in patients with periorbital swelling from local allergic skin reactions from insect bites and decreasing unnecessary imaging studies and hospital admissions.
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