A retrospective study of cellulitis outcomes in Ohio hospitals with or without access to dermatology residency programs

Ly, Nathalie; Goldenberg, Michael; Korman, Abraham M.; Spaccarelli, Natalie; Wang, Henry E.; Chung, Catherine; Kaffenberger, Benjamin H.

doi:10.1111/ijd.15611

Cited by 4 publications

(2 citation statements)

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“…affiliated with dermatology residency programs admit fewer patients with cellulitis and may have better outcomes compared to hospitals without training programs. 26 Greater involvement of dermatologists in the care of patients diagnosed with cellulitis was supported in a systematic review of medical overuse in dermatology. 27 The feasibility of routine dermatology consultations may be limited by disparities in consultant resources outside of tertiary medical centers.…”

Section: Discussionmentioning

confidence: 99%

“…Some support the early involvement of dermatologists in the care of patients with cellulitis 25 . Hospitals affiliated with dermatology residency programs admit fewer patients with cellulitis and may have better outcomes compared to hospitals without training programs 26 . Greater involvement of dermatologists in the care of patients diagnosed with cellulitis was supported in a systematic review of medical overuse in dermatology 27 .…”

Section: Discussionmentioning

confidence: 99%

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Prevalence of misdiagnosis of cellulitis: A systematic review and meta‐analysis

Cutler

Jannat‐Khah

Kam

et al. 2022

Journal of Hospital Medicine

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Background: There is no gold standard test to accurately identify patients with cellulitis and therefore misdiagnosis is common. Using the clinical impression of a dermatology or an infectious disease specialist as a reference standard, we sought to determine the prevalence of misdiagnosis of cellulitis among nonspecialist physicians.Methods: A systemic search was performed using MEDLINE, Cochrane Library, and EMBASE databases for studies reporting diagnostic accuracy of cellulitis. Inclusion criteria required dermatology or infectious disease consultation for all patients diagnosed with cellulitis by generalist physicians. We used random effects modeling to estimate the prevalence of misdiagnosis using consultant diagnosis as a reference standard.Results: Eight studies contributed to the analysis. For the seven studies involving inpatients, the results were sufficiently homogeneous to justify pooling data. Of 858 inpatients initially diagnosed with cellulitis, 335 (39%, 95% confidence interval: 31-47) received an alternative diagnosis from the specialist. Heterogeneity was large (I 2 = 74%) and the greatest contributor to between-study variance was the year of publication. Alternative diagnoses were mostly noninfectious (68%, 221/327), with stasis dermatitis (18%, 60/327) being the most common. An abscess was the most common alternative infectious diagnosis (10%, 32/327).Discussion: Cellulitis is commonly misdiagnosed among inpatients, leading to unnecessary hospital admissions and antibiotic overuse. Most alternative diagnoses are noninfectious. Continuing medical education among general practitioners and urgent care providers will likely reduce cellulitis misdiagnoses. BACKGROUNDCellulitis is a frequently diagnosed infection of the skin and subcutaneous tissue. 1 It is estimated that 14.5 million patients are diagnosed with cellulitis in the United States annually, accounting for 650,000 hospital admissions. 1 Although cellulitis comprises 10% of all infectious disease hospitalizations 2 and 11% of all dermatologic admissions, 3 there is no laboratory test, microbiologic result, or imaging study that can reliably confirm the diagnosis of cellulitis. 4 Diseases that mimic cellulitis are myriad, 5 thus offering ample opportunity for misdiagnosis. 6,7 Cellulitis misdiagnoses can lead to inappropriate treatment with antibiotics, unnecessary hospitalization, and delay in definitive diagnosis and treatment. [8][9][10] Dermatologists have special training and experience in differentiating among diseases of the skin and soft tissue and therefore

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prevalence of misdiagnosis of cellulitis: A systematic review and meta‐analysis

Cutler

Jannat‐Khah

Kam

et al. 2022

Journal of Hospital Medicine

View full text Add to dashboard Cite

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The effect of histopathologic analysis and tissue cultures on inpatient management of cellulitis: a randomized control trial

Lause,

Hansen,

Libson

et al. 2024

Arch Dermatol Res

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Background: In the absence of a gold-standard diagnostic modality for cellulitis, sterile inflammatory disorders may be misdiagnosed as cellulitis. Objective: To determine the utility of skin biopsy and tissue culture for the diagnosis and management of patients admitted with a diagnosis of presumed cellulitis. Design: Pilot single-blind parallel group randomized controlled clinical trial in 56 patients with a primary diagnosis of presumed cellulitis. In the intervention group only, skin biopsy and tissue culture results were made available to the primary care team to guide diagnosis and management. Length of hospital stay and antibiotic use were evaluated as outcome measures. Results: Length of stay showed the greatest opportunity for further study as a primary outcome (intervention: 4, IQR (2–6) vs. control: 5 IQR (3–8) days; p = 0.124). Limitations: The COVID-19 pandemic placed limitations on participant enrollment and study duration; in addition, data was collected from a single medical center. Conclusion: This study demonstrates that length of stay and anti-pseudomonal antibiotic de-escalation are endpoints that may be influenced by biopsy and tissue culture results in presumed cellulitis patients; these outcomes warrant further study.

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