Adam B Raff1, Qing Yu Weng1, Jeffrey M Cohen2, Nicole Gunasekera2, Jean-Phillip Okhovat2, Priyanka Vedak1, Cara Joyce3, Daniela Kroshinsky1, Arash Mostaghimi4. 1. Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts. 2. Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts. 3. Department of Public Health Sciences, Loyola University, Chicago, Illinois. 4. Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts. Electronic address: Amostaghimi@bwh.harvard.edu.
Abstract
BACKGROUND: Cellulitis has many clinical mimickers (pseudocellulitis), which leads to frequent misdiagnosis. OBJECTIVE: To create a model for predicting the likelihood of lower extremity cellulitis. METHODS: A cross-sectional review was performed of all patients admitted with a diagnosis of lower extremity cellulitis through the emergency department at a large hospital between 2010 and 2012. Patients discharged with diagnosis of cellulitis were categorized as having cellulitis, while those given an alternative diagnosis were considered to have pseudocellulitis. Bivariate associations between predictor variables and final diagnosis were assessed to develop a 4-variable model. RESULTS: In total, 79 (30.5%) of 259 patients were misdiagnosed with lower extremity cellulitis. Of the variables associated with true cellulitis, the 4 in the final model were asymmetry (unilateral involvement), leukocytosis (white blood cell count ≥10,000/uL), tachycardia (heart rate ≥90 bpm), and age ≥70 years. We converted these variables into a points system to create the ALT-70 cellulitis score as follows: Asymmetry (3 points), Leukocytosis (1 point), Tachycardia (1 point), and age ≥70 (2 points). With this score, 0-2 points indicate ≥83.3% likelihood of pseudocellulitis, and ≥5 points indicate ≥82.2% likelihood of true cellulitis. LIMITATIONS: Prospective validation of this model is needed before widespread clinical use. CONCLUSION: Asymmetry, leukocytosis, tachycardia, and age ≥70 are predictive of lower extremity cellulitis. This model might facilitate more accurate diagnosis and improve patient care.
BACKGROUND:Cellulitis has many clinical mimickers (pseudocellulitis), which leads to frequent misdiagnosis. OBJECTIVE: To create a model for predicting the likelihood of lower extremity cellulitis. METHODS: A cross-sectional review was performed of all patients admitted with a diagnosis of lower extremity cellulitis through the emergency department at a large hospital between 2010 and 2012. Patients discharged with diagnosis of cellulitis were categorized as having cellulitis, while those given an alternative diagnosis were considered to have pseudocellulitis. Bivariate associations between predictor variables and final diagnosis were assessed to develop a 4-variable model. RESULTS: In total, 79 (30.5%) of 259 patients were misdiagnosed with lower extremity cellulitis. Of the variables associated with true cellulitis, the 4 in the final model were asymmetry (unilateral involvement), leukocytosis (white blood cell count ≥10,000/uL), tachycardia (heart rate ≥90 bpm), and age ≥70 years. We converted these variables into a points system to create the ALT-70 cellulitis score as follows: Asymmetry (3 points), Leukocytosis (1 point), Tachycardia (1 point), and age ≥70 (2 points). With this score, 0-2 points indicate ≥83.3% likelihood of pseudocellulitis, and ≥5 points indicate ≥82.2% likelihood of true cellulitis. LIMITATIONS: Prospective validation of this model is needed before widespread clinical use. CONCLUSION: Asymmetry, leukocytosis, tachycardia, and age ≥70 are predictive of lower extremity cellulitis. This model might facilitate more accurate diagnosis and improve patient care.
Authors: Trent D Walker; Ty W Gilkey; John Christopher Trinidad; Catherine G Chung; Henry Wang; Arash Mostaghimi; Benjamin H Kaffenberger Journal: Arch Dermatol Res Date: 2022-10-23 Impact factor: 3.033
Authors: David G Li; Fan Di Xia; Hasan Khosravi; Anna K Dewan; Daniel J Pallin; Christopher W Baugh; Karl Laskowski; Cara Joyce; Arash Mostaghimi Journal: JAMA Dermatol Date: 2018-05-01 Impact factor: 10.282
Authors: M Patel; S I Lee; R K Akyea; D Grindlay; N Francis; N J Levell; P Smart; J Kai; K S Thomas Journal: Br J Dermatol Date: 2019-06-28 Impact factor: 9.302