Breast ultrasound utilization in a safety net emergency department

Jessica H Porembka, Lindsay Compton, Lena Omar, Pooja Sharma, Haley Clark, Richard Ahn, Ramapriya Ganti, Yin Xi, Jeffery Metzger, John Leyendecker

Research output: Contribution to journalArticle

Abstract

Purpose: The purpose of this study is to (1) assess the diagnostic yield of ultrasounds performed in the emergency department for suspected breast abscess and determine the rates of reimaging, discordance, and emergent intervention in a large, busy safety net hospital and (2) determine clinical factors significantly associated with abscess as a way to improve patient selection for emergent breast ultrasounds. Methods: A total of 581 consecutive breast ultrasounds performed in the emergency department for suspected abscess over 15 months were retrospectively reviewed for imaging, demographics, laboratory data, and physical exam findings. Breast abscess was confirmed by combining imaging, clinical, and laboratory data. Linear logistic regression analysis estimated the likelihood of abscess, and the cross-validated area under the receiver operating characteristic curve (AUC) evaluated diagnostic performance. Results: Final diagnoses included abscess (153/581, 26%), cancer (29/581, 5%), granulomatous mastitis (41/581, 7%), normal (120/581, 21%), and other/indeterminate (238/581, 41%). Factors associated with abscess included induration, fluctuance, erythema, drainage, smoking, diabetes, and Black race. Based on these factors, the AUC of the characteristics predictive of abscess was 0.77 (CI, 0.72–0.81). Six breast cancers were not diagnosed on ultrasound. 40% of ultrasounds (231/581) were considered incomplete/inadequate. Conclusion: 74% (428/581) of emergent breast ultrasounds in our population were negative for abscess, while 21% (6/29) of cancers were not diagnosed, and 40% (231/581) of exams were incomplete/inadequate. Patient selection for emergent ultrasounds can be improved, allowing patients with a low likelihood of abscess to be imaged in a more optimal setting.

Original languageEnglish (US)
JournalEmergency Radiology
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Abscess
Hospital Emergency Service
Breast
Safety
Patient Selection
Area Under Curve
Granulomatous Mastitis
Safety-net Providers
Erythema
ROC Curve
Drainage
Linear Models
Ultrasonography
Neoplasms
Logistic Models
Smoking
Regression Analysis
Demography
Breast Neoplasms

Keywords

  • Breast abscess
  • Breast emergencies
  • Breast ultrasound
  • Emergency radiology

ASJC Scopus subject areas

  • Emergency Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Breast ultrasound utilization in a safety net emergency department. / Porembka, Jessica H; Compton, Lindsay; Omar, Lena; Sharma, Pooja; Clark, Haley; Ahn, Richard; Ganti, Ramapriya; Xi, Yin; Metzger, Jeffery; Leyendecker, John.

In: Emergency Radiology, 01.01.2018.

Research output: Contribution to journalArticle

Porembka, Jessica H ; Compton, Lindsay ; Omar, Lena ; Sharma, Pooja ; Clark, Haley ; Ahn, Richard ; Ganti, Ramapriya ; Xi, Yin ; Metzger, Jeffery ; Leyendecker, John. / Breast ultrasound utilization in a safety net emergency department. In: Emergency Radiology. 2018.
@article{8f0a7102af1d47c39dae0935e21a5c8f,
title = "Breast ultrasound utilization in a safety net emergency department",
abstract = "Purpose: The purpose of this study is to (1) assess the diagnostic yield of ultrasounds performed in the emergency department for suspected breast abscess and determine the rates of reimaging, discordance, and emergent intervention in a large, busy safety net hospital and (2) determine clinical factors significantly associated with abscess as a way to improve patient selection for emergent breast ultrasounds. Methods: A total of 581 consecutive breast ultrasounds performed in the emergency department for suspected abscess over 15 months were retrospectively reviewed for imaging, demographics, laboratory data, and physical exam findings. Breast abscess was confirmed by combining imaging, clinical, and laboratory data. Linear logistic regression analysis estimated the likelihood of abscess, and the cross-validated area under the receiver operating characteristic curve (AUC) evaluated diagnostic performance. Results: Final diagnoses included abscess (153/581, 26{\%}), cancer (29/581, 5{\%}), granulomatous mastitis (41/581, 7{\%}), normal (120/581, 21{\%}), and other/indeterminate (238/581, 41{\%}). Factors associated with abscess included induration, fluctuance, erythema, drainage, smoking, diabetes, and Black race. Based on these factors, the AUC of the characteristics predictive of abscess was 0.77 (CI, 0.72–0.81). Six breast cancers were not diagnosed on ultrasound. 40{\%} of ultrasounds (231/581) were considered incomplete/inadequate. Conclusion: 74{\%} (428/581) of emergent breast ultrasounds in our population were negative for abscess, while 21{\%} (6/29) of cancers were not diagnosed, and 40{\%} (231/581) of exams were incomplete/inadequate. Patient selection for emergent ultrasounds can be improved, allowing patients with a low likelihood of abscess to be imaged in a more optimal setting.",
keywords = "Breast abscess, Breast emergencies, Breast ultrasound, Emergency radiology",
author = "Porembka, {Jessica H} and Lindsay Compton and Lena Omar and Pooja Sharma and Haley Clark and Richard Ahn and Ramapriya Ganti and Yin Xi and Jeffery Metzger and John Leyendecker",
year = "2018",
month = "1",
day = "1",
doi = "10.1007/s10140-018-1651-6",
language = "English (US)",
journal = "Emergency Radiology",
issn = "1070-3004",
publisher = "Springer New York",

}

TY - JOUR

T1 - Breast ultrasound utilization in a safety net emergency department

AU - Porembka, Jessica H

AU - Compton, Lindsay

AU - Omar, Lena

AU - Sharma, Pooja

AU - Clark, Haley

AU - Ahn, Richard

AU - Ganti, Ramapriya

AU - Xi, Yin

AU - Metzger, Jeffery

AU - Leyendecker, John

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Purpose: The purpose of this study is to (1) assess the diagnostic yield of ultrasounds performed in the emergency department for suspected breast abscess and determine the rates of reimaging, discordance, and emergent intervention in a large, busy safety net hospital and (2) determine clinical factors significantly associated with abscess as a way to improve patient selection for emergent breast ultrasounds. Methods: A total of 581 consecutive breast ultrasounds performed in the emergency department for suspected abscess over 15 months were retrospectively reviewed for imaging, demographics, laboratory data, and physical exam findings. Breast abscess was confirmed by combining imaging, clinical, and laboratory data. Linear logistic regression analysis estimated the likelihood of abscess, and the cross-validated area under the receiver operating characteristic curve (AUC) evaluated diagnostic performance. Results: Final diagnoses included abscess (153/581, 26%), cancer (29/581, 5%), granulomatous mastitis (41/581, 7%), normal (120/581, 21%), and other/indeterminate (238/581, 41%). Factors associated with abscess included induration, fluctuance, erythema, drainage, smoking, diabetes, and Black race. Based on these factors, the AUC of the characteristics predictive of abscess was 0.77 (CI, 0.72–0.81). Six breast cancers were not diagnosed on ultrasound. 40% of ultrasounds (231/581) were considered incomplete/inadequate. Conclusion: 74% (428/581) of emergent breast ultrasounds in our population were negative for abscess, while 21% (6/29) of cancers were not diagnosed, and 40% (231/581) of exams were incomplete/inadequate. Patient selection for emergent ultrasounds can be improved, allowing patients with a low likelihood of abscess to be imaged in a more optimal setting.

AB - Purpose: The purpose of this study is to (1) assess the diagnostic yield of ultrasounds performed in the emergency department for suspected breast abscess and determine the rates of reimaging, discordance, and emergent intervention in a large, busy safety net hospital and (2) determine clinical factors significantly associated with abscess as a way to improve patient selection for emergent breast ultrasounds. Methods: A total of 581 consecutive breast ultrasounds performed in the emergency department for suspected abscess over 15 months were retrospectively reviewed for imaging, demographics, laboratory data, and physical exam findings. Breast abscess was confirmed by combining imaging, clinical, and laboratory data. Linear logistic regression analysis estimated the likelihood of abscess, and the cross-validated area under the receiver operating characteristic curve (AUC) evaluated diagnostic performance. Results: Final diagnoses included abscess (153/581, 26%), cancer (29/581, 5%), granulomatous mastitis (41/581, 7%), normal (120/581, 21%), and other/indeterminate (238/581, 41%). Factors associated with abscess included induration, fluctuance, erythema, drainage, smoking, diabetes, and Black race. Based on these factors, the AUC of the characteristics predictive of abscess was 0.77 (CI, 0.72–0.81). Six breast cancers were not diagnosed on ultrasound. 40% of ultrasounds (231/581) were considered incomplete/inadequate. Conclusion: 74% (428/581) of emergent breast ultrasounds in our population were negative for abscess, while 21% (6/29) of cancers were not diagnosed, and 40% (231/581) of exams were incomplete/inadequate. Patient selection for emergent ultrasounds can be improved, allowing patients with a low likelihood of abscess to be imaged in a more optimal setting.

KW - Breast abscess

KW - Breast emergencies

KW - Breast ultrasound

KW - Emergency radiology

UR - http://www.scopus.com/inward/record.url?scp=85055884014&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85055884014&partnerID=8YFLogxK

U2 - 10.1007/s10140-018-1651-6

DO - 10.1007/s10140-018-1651-6

M3 - Article

C2 - 30377859

AN - SCOPUS:85055884014

JO - Emergency Radiology

JF - Emergency Radiology

SN - 1070-3004

ER -