Point-of-Care Ultrasound Educational Initiative for Insect Bites
| Status: | Recruiting |
|---|---|
| Conditions: | Cosmetic |
| Therapuetic Areas: | Dermatology / Plastic Surgery |
| Healthy: | No |
| Age Range: | Any - 20 |
| Updated: | 9/19/2018 |
| Start Date: | August 10, 2018 |
| End Date: | August 2020 |
| Contact: | James A Meltzer, MD, MS |
| Email: | james.meltzer@nychhc.org |
| Phone: | 718-918-5826 |
The Utility of a Point-of-Care Ultrasound Educational Initiative in Decreasing Unnecessary Antibiotic Use in Children With Local Reactions From Insect Bites
This pre-post study, designed to decrease unnecessary antibiotic prescribing, will use a
prospective cohort of patients presenting to the Pediatric Emergency Department (PED).
Patients with local skin findings that the clinician believes are primarily due to an insect
bite or sting will be approached for the study.
The intervention will occur at the physician level. Midway through the study, physicians will
receive an educational intervention describing how to differentiate cellulitis from allergic
reaction using point-of-care bedside ultrasound.
The main outcome observed will be whether or not the patient receives a prescription for
antibiotics at the index visit.
prospective cohort of patients presenting to the Pediatric Emergency Department (PED).
Patients with local skin findings that the clinician believes are primarily due to an insect
bite or sting will be approached for the study.
The intervention will occur at the physician level. Midway through the study, physicians will
receive an educational intervention describing how to differentiate cellulitis from allergic
reaction using point-of-care bedside ultrasound.
The main outcome observed will be whether or not the patient receives a prescription for
antibiotics at the index visit.
Thousands of children each year develop soft tissue swelling after an insect bite or sting
and present shortly after to emergency departments (ED) across the United States. These
wounds are particularly pruritic and can become self-inoculated with skin flora resulting in
cellulitis. Clinicians who suspect cellulitis will typically prescribe oral antibiotics to
treat this condition. Cellulitis, however, can be confused with a local allergic reaction to
the insect bite because the physical examination findings are nearly identical. As such, the
reliability of clinical examination in the diagnosis of pediatric skin and soft tissue
infections is poor. Consequently, many patients with local allergic reactions are treated
unnecessarily with antibiotics.
Patients who take antibiotics may experience unintended and unpleasant side effects such as
diarrhea and allergic reactions. Moreover, unnecessary antibiotic prescribing is an important
factor in the development of antibiotic-resistant infections which are estimated to affect 2
million patients and result in 23 thousand deaths each year in the United States. The medical
community has thus sought innovative approaches to reducing unnecessary antibiotic use.
The goal of this study is to reduce unnecessary antibiotic prescriptions for children with
insect bites that are not infected. This quality improvement initiative will focus on
children with insect bites presenting to the Pediatric Emergency Department at Jacobi Medical
Center (Bronx, NY). The pre-intervention phase will consist of patients enrolled prior to the
physicians receiving a Point-of-Care Ultrasound (POCUS) Educational Intervention. The
post-intervention phase will consist of patients enrolled after the physicians have received
a POCUS Educational Intervention. In both phases, the physician will be able to care for the
patient however he or she believes is appropriate.
The POCUS Education Intervention will supplement the baseline knowledge of the Pediatric
Emergency Medicine physician with regards to performing a soft-tissue examination using
POCUS. A POCUS expert will train all clinicians how to properly perform a soft tissue
examination using POCUS to differentiate between cellulitis and local reactions due to
angioedema/allergic reaction. The education will include a formal lecture and practical
clinical examination. The proportion of patients receiving antibiotics will be compared
before and after the Educational Initiative had started. All patients will be contacted 3 to
5 days after their initial emergency department visit to determine if the patient's condition
worsened, if the patient needed to return to a healthcare provider, and if the patient had
taken any antibiotics.
and present shortly after to emergency departments (ED) across the United States. These
wounds are particularly pruritic and can become self-inoculated with skin flora resulting in
cellulitis. Clinicians who suspect cellulitis will typically prescribe oral antibiotics to
treat this condition. Cellulitis, however, can be confused with a local allergic reaction to
the insect bite because the physical examination findings are nearly identical. As such, the
reliability of clinical examination in the diagnosis of pediatric skin and soft tissue
infections is poor. Consequently, many patients with local allergic reactions are treated
unnecessarily with antibiotics.
Patients who take antibiotics may experience unintended and unpleasant side effects such as
diarrhea and allergic reactions. Moreover, unnecessary antibiotic prescribing is an important
factor in the development of antibiotic-resistant infections which are estimated to affect 2
million patients and result in 23 thousand deaths each year in the United States. The medical
community has thus sought innovative approaches to reducing unnecessary antibiotic use.
The goal of this study is to reduce unnecessary antibiotic prescriptions for children with
insect bites that are not infected. This quality improvement initiative will focus on
children with insect bites presenting to the Pediatric Emergency Department at Jacobi Medical
Center (Bronx, NY). The pre-intervention phase will consist of patients enrolled prior to the
physicians receiving a Point-of-Care Ultrasound (POCUS) Educational Intervention. The
post-intervention phase will consist of patients enrolled after the physicians have received
a POCUS Educational Intervention. In both phases, the physician will be able to care for the
patient however he or she believes is appropriate.
The POCUS Education Intervention will supplement the baseline knowledge of the Pediatric
Emergency Medicine physician with regards to performing a soft-tissue examination using
POCUS. A POCUS expert will train all clinicians how to properly perform a soft tissue
examination using POCUS to differentiate between cellulitis and local reactions due to
angioedema/allergic reaction. The education will include a formal lecture and practical
clinical examination. The proportion of patients receiving antibiotics will be compared
before and after the Educational Initiative had started. All patients will be contacted 3 to
5 days after their initial emergency department visit to determine if the patient's condition
worsened, if the patient needed to return to a healthcare provider, and if the patient had
taken any antibiotics.
Inclusion Criteria:
- Erythema or swelling surrounding an insect bite or sting for greater than 12 hours
Exclusion Criteria:
- Patients with skin findings consistent with an abscess (ie. active drainage,
fluctuance)
- Patients who are relatively immunocompromised (e.g., patients with AIDS, diabetes
mellitus, cancer)
- Recent use of antibiotics within 1 week prior to symptoms
- Pregnant
- Altered mental status
- Unable to provide a phone number for follow-up
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