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situations
as
well,
but
only
after
reasonable
justification
and
consideration
of
side
effects
to
the
child.
Currently one of
the drawbacks
to
the use of bedside ultrasound
may be
its availability. At
this
institution, an ultrasound
technician
may
not
be
consistently
available
overnight
or
on
the weekend
although
this
is
changing.
The
availability
of
ultrasound
may
improve
as
its
demand
increases
across
all
fields
of medicine.
To
improve availability,
it may be necessary
to
specify
the need
for an
ultrasound
technician
during
extended
periods.
It
also
may
be
beneficial
for
more
physicians
including
otolaryngologists
to
become
proficient
in
performing
and
interpreting
ultrasound
so
that
it may be used whenever children present with symptoms of a
serious
abscess.
The
decision
to
perform
an
ultrasound was
based
on
clinician
preference and availability of ultrasound
technicians
in
this
study.
In
the
absence
of
a
truly
randomized
study,
some
selection
bias
may
exist.
It
may
not
be
ethical
to
perform
a
randomized
controlled
trial
in
the
interest
of
cost
and
potential
harm
to
the
child
from
a
CT.
The
reported
data
are
based
on
patients
who
underwent
a
diagnostic
screening
test,
CT
and/or
ultrasound,
and
the
gold
standard
test,
drainage
of
the
abscess.
There
is
potential
for
verification
bias
because
not
all
patients who
underwent
an
initial
screening
test
also
underwent
the
definitive
gold
standard
test. Many
of
our
patients with
cervical
adenitis
and
a
suspected
abscess
will
resolve
clinically
without
undergoing
incision
and
drainage. Also, not all childrenwho underwent the gold standard at
this
institution underwent
an
imaging
study prior
to
incision
and
drainage.
These
two
groups were
not
evaluated
in
this
study.
As
previous
studies
recognize,
ultrasound
interpretation
is
operator
dependent
[2]
.
Computed
tomography
is
subject
to
variations
in
operation
and
interpretation
as well
[12]
.
Therefore,
the
ability
to
reproduce
the
results of
this study may be affected by
the specialty
and
level
of
expertise
of
the
examiner.
In
the
absence
of
otolaryngologists
who
are
comfortable
interpreting
ultrasound,
studies examining
its use
in
the field may continue
to be
limited by
this
factor.
Another
limitation of
this
study
is
the
small number of
subjects
with pus-negative abscesses
(
n
= 16). This decreased
the precision
of
our
estimate
of
the
specificity
for
both
ultrasound
and
CT.
Without needlessly
imaging patients who have a
low probability of
an
abscess,
these numbers
are unlikely
to
increase. Expanding
the
enrollment
through
a
future multicenter
study may
address
this
limitation.
It
is
also
important
to
note
that
the
positive
and
negative
predictive
values
are
influenced
by
the
assumed
true
prevalence
of
abscess
positivity
in
the
population. We
expect
the
positive
predictive
value
to
be
high
and
the
negative
predictive
value
to be
low
in
settings with a high prevalence,
such as
tertiary
care
centers
similar
to
ours.
5. Conclusion
The sensitivity of ultrasound and CT
in
the diagnosis of pediatric
lateral
neck
abscesses
is
similar,
yet
ultrasound
may
be
more
specific when
compared
to
the
outcome
of
attempted
drainage.
The use of an ultrasound
in
the diagnosis of a
lateral neck abscess
in
a
child may provide
similar
information
to
the
clinician at
a
lower
cost and
lower
risk
to
the
child
compared
to CT. As
such,
it may be
preferred
for
diagnosis
in
many
situations.
We
propose
that
ultrasound
should
be
considered
prior
to
requesting
a
CT
scan.
Financial
disclosure
information
No
financial
or material
support
for
this
research
to
disclose.
The
authors have
no financial
interest
in
companies
or
entities
to
disclose.
Conflict
of
interest
The authors have no conflicts of
interest
to disclose, financial or
otherwise.
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