M Patel1,2, S I Lee1, K S Thomas2, J Kai1. 1. Division of Primary Care & National Institute for Health Research, University of Nottingham, Nottingham, U.K. 2. Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K.
Abstract
BACKGROUND: Presentations of suspected lower-limb cellulitis are commonly misdiagnoses, resulting in avoidable antibiotic prescribing or hospital admissions. Understanding the challenges posed in diagnosing cellulitis may help enhance future care. OBJECTIVES: To examine and map out the challenges and facilitators identified by patients and health professionals in diagnosing lower-limb cellulitis. METHODS: A scoping systematic review was performed in MEDLINE and Embase in October 2017. Thematic analysis was used to identify key themes. Quantitative data were summarized by narrative synthesis. RESULTS: Three themes were explored: (i) clinical case reports of misdiagnosis, (ii) service development and (iii) diagnostic aids. Forty-seven different pathologies were misdiagnosed, including seven malignancies. Two different services have been piloted to reduce the misdiagnosis rates of lower-limb cellulitis and save costs. Four studies have looked at biochemical markers, imaging and a scoring tool to aid diagnosis. CONCLUSIONS: This review highlights the range of alternative pathologies that can be misdiagnosed as cellulitis, and emerging services and diagnostic aids developed to minimize misdiagnosis. Future work should focus on gaining a greater qualitative understanding of the diagnostic challenges from the perspective of patients and clinicians.
BACKGROUND: Presentations of suspected lower-limb cellulitis are commonly misdiagnoses, resulting in avoidable antibiotic prescribing or hospital admissions. Understanding the challenges posed in diagnosing cellulitis may help enhance future care. OBJECTIVES: To examine and map out the challenges and facilitators identified by patients and health professionals in diagnosing lower-limb cellulitis. METHODS: A scoping systematic review was performed in MEDLINE and Embase in October 2017. Thematic analysis was used to identify key themes. Quantitative data were summarized by narrative synthesis. RESULTS: Three themes were explored: (i) clinical case reports of misdiagnosis, (ii) service development and (iii) diagnostic aids. Forty-seven different pathologies were misdiagnosed, including seven malignancies. Two different services have been piloted to reduce the misdiagnosis rates of lower-limb cellulitis and save costs. Four studies have looked at biochemical markers, imaging and a scoring tool to aid diagnosis. CONCLUSIONS: This review highlights the range of alternative pathologies that can be misdiagnosed as cellulitis, and emerging services and diagnostic aids developed to minimize misdiagnosis. Future work should focus on gaining a greater qualitative understanding of the diagnostic challenges from the perspective of patients and clinicians.
Authors: Mitesh Patel; Siang Ing Lee; Nick J Levell; Peter Smart; Joe Kai; Kim S Thomas; Paul Leighton Journal: Br J Gen Pract Date: 2020-01-30 Impact factor: 5.386
Authors: Mitesh Patel; Siang Ing Lee; Nick J Levell; Peter Smart; Joe Kai; Kim S Thomas; Paul Leighton Journal: BMJ Open Date: 2020-10-14 Impact factor: 2.692