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World Journal of Emergency Medicine ›› 2024, Vol. 15 ›› Issue (4): 283-288.doi: 10.5847/wjem.j.1920-8642.2024.049

• Original Articles • Previous Articles     Next Articles

Evaluation of hand infections in the emergency department using point-of-care ultrasound

David Ahmad Haidar1(), David Mintz2, Brandon M Wubben3, Omar Rizvi4, Srikar Adhikari5   

  1. 1Department of Emergency Medicine, Michigan Medicine, Ann Arbor 48109-1382, USA
    2University of Arizona College of Medicine, Tucson 85724, USA
    3Department of Emergency Medicine, University of Iowa, Iowa City 52242-1009, USA
    4Department of Surgery, University of Arizona College of Medicine, Tucson 85724, USA
    5Department of Emergency Medicine, University of Arizona College of Medicine, Tucson 85724, USA
  • Received:2023-09-22 Accepted:2023-12-19 Online:2024-07-15 Published:2024-07-01
  • Contact: David Ahmad Haidar E-mail:dahaidar@med.umich.ed


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.

CONCLUSION: 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.

Key words: Ultrasound, Point-of-care ultrasound, Cellulitis, Abscess, Flexor tenosynovitis