{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,10]],"date-time":"2026-01-10T09:02:55Z","timestamp":1768035775560,"version":"3.49.0"},"reference-count":11,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Pediatr Emer Care"],"published-print":{"date-parts":[[2022,2]]},"abstract":"\n Objectives<\/jats:title>\n To evaluate whether ultrasound can differentiate between cellulitis and angioedema from insect bites in pediatric patients.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A prospective, pre-post study in an urban pediatric emergency department of patients younger than 21 years with soft tissue swelling from insect bites without abscesses were enrolled. Treating physician's pretest opinions regarding the diagnosis and need for antibiotics were determined. Ultrasound of the affected areas was performed, and effects on management were recorded. Further imaging, medications, and disposition were at the discretion of the enrolling physician. Phone call follow-ups were made within a week of presentation.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among 103 patients enrolled with soft tissue swelling secondary to insect bites, ultrasound changed the management in 27 (26%) patients (95% confidence interval [CI], 18\u201335%). Of the patients who were indeterminate or believed to require antibiotics, ultrasound changed management in 6 (23%) of 26 patients (95% CI, 6%\u201340%). In those patients who were believed not to require antibiotics, ultrasound changed management in 12 (16%) 77 patients (95% CI, 7%\u201324%). Patients with diagnosis of local angioedema achieved symptom resolution 1.4 days sooner than patients diagnosed with cellulitis (mean, \u22121.389; 95% CI, \u22122.087 to \u22120.690; P<\/jats:italic> < 0.001). No patient who was initially diagnosed as local angioedema received antibiotics upon patient follow-up.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Point-of-care ultrasound changed physician management in 1 of 4 patients in the pediatric emergency department with soft tissue swelling secondary to insect bites. Ultrasound may guide the management in these patients and lead to improved antibiotic stewardship in conjunction with history and physical examination.<\/jats:p>\n <\/jats:sec>","DOI":"10.1097\/pec.0000000000002416","type":"journal-article","created":{"date-parts":[[2021,4,5]],"date-time":"2021-04-05T00:04:42Z","timestamp":1617581082000},"page":"e674-e677","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":4,"title":["Point-of-Care Ultrasound on Management of Cellulitis Versus Local Angioedema in the Pediatric Emergency Department"],"prefix":"10.1097","volume":"38","author":[{"given":"Ee Tein","family":"Tay","sequence":"first","affiliation":[{"name":"Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ka Ming","family":"Ngai","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James W.","family":"Tsung","sequence":"additional","affiliation":[{"name":"Department of Pediatric Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer E.","family":"Sanders","sequence":"additional","affiliation":[{"name":"Department of Pediatric Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2021,4,23]]},"reference":[{"key":"bib1-20250504","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1017\/S0950268816002855","article-title":"Incidence and factors associated with emergency department visits for recurrent skin and soft tissue infections in patients in California, 2005\u20132011","volume":"145","year":"2017","journal-title":"Epidemiol Infect"},{"key":"bib2-20250504","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1016\/S0140-6736(00)04171-4","article-title":"Ascending cellulitis after an insect bite","volume":"357","year":"2001","journal-title":"Lancet"},{"key":"bib3-20250504","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1016\/j.jemermed.2009.05.013","article-title":"Effect of bedside ultrasound on management of pediatric soft-tissue infection","volume":"39","year":"2010","journal-title":"J Emerg Med"},{"key":"bib4-20250504","first-page":"384","article-title":"The effect of soft-tissue ultrasound on the management of cellulitis in the emergency department","volume":"13","year":"2006","journal-title":"Acad Emerg Med Off J Soc Acad Emerg Med"},{"key":"bib5-20250504","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1097\/PEC.0b013e318191d963","article-title":"Ultrasound soft-tissue applications in the pediatric emergency department: to drain or not to drain?","volume":"25","year":"2009","journal-title":"Pediatr Emerg Care"},{"key":"bib6-20250504","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1197\/j.aem.2005.01.016","article-title":"ABSCESS: applied bedside sonography for convenient evaluation of superficial soft tissue infections","volume":"12","year":"2005","journal-title":"Acad Emerg Med Off J Soc Acad Emerg Med"},{"key":"bib7-20250504","doi-asserted-by":"crossref","first-page":"1501","DOI":"10.1542\/peds.2005-2890","article-title":"Ultrasound examination of extensive limb swelling reactions after diphtheria-tetanus-acellular pertussis or reduced-antigen content diphtheria-tetanus-acellular pertussis immunization in preschool-aged children","volume":"118","year":"2006","journal-title":"Pediatrics"},{"key":"bib8-20250504","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1111\/j.1600-0536.1987.tb02665.x","article-title":"Ultrasound for Assessment of Allergic and Irritant Patch Test Reactions","volume":"17","year":"1987","journal-title":"Contact Dermatitis"},{"key":"bib9-20250504","doi-asserted-by":"crossref","first-page":"1705","DOI":"10.7863\/ultra.33.9.1705","article-title":"Sonographic appearance of angioedema in local allergic reactions to insect bites and stings","volume":"33","year":"2014","journal-title":"J Ultrasound Med"},{"key":"bib10-20250504","doi-asserted-by":"crossref","first-page":"537","DOI":"10.3109\/00365548909037882","article-title":"The etiology of bacterial cellulitis as determined by fine-needle aspiration","volume":"21","year":"1989","journal-title":"Scand J Infect Dis"},{"key":"bib11-20250504","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1001\/archinte.1989.00390020039008","article-title":"Quantitative cultures of biopsy specimens from cutaneous cellulitis","volume":"149","year":"1989","journal-title":"Arch Intern Med"}],"container-title":["Pediatric Emergency Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/PEC.0000000000002416","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,4]],"date-time":"2025-05-04T19:01:29Z","timestamp":1746385289000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/PEC.0000000000002416"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,23]]},"references-count":11,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2022]]}},"URL":"https:\/\/doi.org\/10.1097\/pec.0000000000002416","relation":{},"ISSN":["1535-1815","0749-5161"],"issn-type":[{"value":"1535-1815","type":"electronic"},{"value":"0749-5161","type":"print"}],"subject":[],"published":{"date-parts":[[2021,4,23]]}}}