No Concurrence in Identifying Cutaneous Abscesses

Este artículo es muy interesante sobre la diferencia entre absceso y celulitis y como tratarlo.

Saludos 

Dr. Carlos Erazo

"Physician agreement on the presence of abscess and the need for drainage was only fair to moderate.

Most cutaneous abscesses require incision and drainage but not systemic antibiotics. By contrast, patients with cellulitis need systemic antibiotics, but incision and drainage are unnecessary and sometimes harmful. Distinguishing between these two disorders, therefore, is important, but how often do clinicians agree in their diagnoses of these conditions?

In this study from an emergency department in an urban, tertiary-care, pediatric hospital, 349 immunocompetent children with 394 lesions affecting the abdomen, legs, buttocks, or arms were evaluated for presence of an abscess and for the necessity for drainage. Each patient was independently examined by two physicians from a pool of 62 clinicians. The amount of agreement among the physicians was assessed by kappa statistic (poor, <0.0; slight, 0.0–0.20; fair, 0.21–0.40; moderate, 0.41–0.60; substantial, 0.61–0.8; nearly perfect, 0.81–1.00). The kappa value for agreement was 0.39 on the presence of an abscess (fair) and 0.43 on the necessity for drainage (moderate). More-experienced examiner pairs did not have better agreement than less seasoned physicians.

Comment: This study demonstrates a substantial and disturbing lack of agreement among clinicians about fundamental issues in children with apparent skin infections — namely, whether a cutaneous abscess was present and whether drainage was required. The relevance of this study to adult patients is uncertain but deserves investigation. My own experience in adults suggests that results might be similar, for I have seen many cutaneous abscesses misdiagnosed as cellulitis by emergency department physicians, internists, and even surgeons, who prescribed antibiotics without benefit. Better training in distinguishing between these entities may improve both the accuracy of diagnosis and the appropriate management of these common skin infections."

— Jan V. Hirschmann, MD

Published in Journal Watch Dermatology January 7, 2011