Point-of-care ultrasound for the evaluation of dental abscesses in the pediatric emergency department.

BACKGROUND

Facial cellulitis is a common presentation at pediatric emergency departments. Prompt diagnosis of dentoalveolar abscesses is crucial for initiating appropriate treatment and minimizing morbidity. While imaging modalities such as computed tomography (CT) and a panoramic X-ray are available, they are not often used for pediatric patients given the known risks of exposure to radiation and the need for sedation.

METHODS

We conducted a prospective diagnostic accuracy study at a tertiary pediatric emergency department to evaluate point-of-care ultrasound (POCUS, index test) for diagnosing dentoalveolar abscesses in children aged 0-18 years. The reference standard was surgical drainage findings by a maxillofacial surgeon. Pediatric emergency medicine physicians performed soft tissue facial ultrasounds following brief standardized training. Diagnostic accuracy was assessed by calculating sensitivity, specificity, positive predictive value, and negative predictive value. Abscess volume was calculated using the ellipsoid formula.

RESULTS

Thirty-three patients were recruited. POCUS demonstrated a sensitivity of 100% (95% CI 84.6-100), specificity of 64% (95% CI 30.8-89.1), positive predictive value of 85% (95% CI 65.1-95.6), and negative predictive value of 100% (95% CI 59.0-100).The abscess volume, as calculated using ultrasound, ranged from 0.004 to 2.16 cm3.

CONCLUSION

These findings demonstrate that point-of-care ultrasound is a valuable diagnostic tool for frontline emergency physicians, allowing accurate bedside identification of dentoalveolar abscesses and guiding timely management while minimizing unnecessary imaging and procedures.