Impact of dermatology and teledermatology consultations for patients admitted with cellulitis: A pilot study

Gupta, Preeta; Tolliver, Starling; Zhang, Myron; Schumacher, Eric R.; Kaffenberger, Benjamin H.

doi:10.1016/j.jaad.2019.09.022

Cited by 17 publications

(8 citation statements)

References 5 publications

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“…On further review, we excluded four observational studies in which the referral process was not uniform and in which there was a risk of selection bias. 8,9,11,15 Of the eight included studies, four were observational in design [16][17][18][19] and four were randomized controlled trials [20][21][22][23] (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…Teledermatology was used in two studies 22,23 in our meta-analysis to identify patients misdiagnosed with cellulitis and has been recommended as an option in areas with limited consultant access. 28 It is notable that our results suggest that cellulitis misdiagnosis is increasing with time.…”

Section: Discussionmentioning

confidence: 99%

“…The feasibility of routine dermatology consultations may be limited by disparities in consultant resources outside of tertiary medical centers. Teledermatology was used in two studies 22,23 in our meta‐analysis to identify patients misdiagnosed with cellulitis and has been recommended as an option in areas with limited consultant access 28 …”

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: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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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“…Our data suggest a need to prioritize the expansion of consistent dermatology access or dermatology residency programs to more hospitals in order to prevent harm, reduce costs, and improve quality of care. Teledermatology may provide an innovative solution to address this disparity as it has been validated for cellulitis through high agreement rates between dermatologists for diagnosis, discharge, and antibiotic management plans 4,5 . Our study was limited by the use of deidentified aggregate data with limited covariables provided and censoring of hospital data when fewer than 11 discharges per year occurred.…”

Section: Variable Ohio Hospitals With a Dermatology Residency Program (N = 8) Ohio Hospitals Without A Dermatology Residency Program (N =mentioning

confidence: 99%

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

Goldenberg

Korman

et al. 2021

Int J Dermatology

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“…4 Early dermatology consultation in hospitalized patients with suspected cellulitis is associated with reduced admission rates, length of stay, and antibiotic use, but is unlikely to scale to the scope of the problem. 5,6 New tools are needed. Evidenced-based CDS tools may be useful point-of-care diagnostic aids, such as described by Dezman et al, 1 successfully limiting admissions and unnecessary antibiotic use.…”

mentioning

confidence: 99%

Moving goalposts: A call for diagnostic advancements and a consensus gold‐standard in patients with cellulitis to improve research rigor

Kirven,

Wang,

Kaffenberger

2023

JACEP Open

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Impact of dermatology and teledermatology consultations for patients admitted with cellulitis: A pilot study

Cited by 17 publications

References 5 publications

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

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

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

Moving goalposts: A call for diagnostic advancements and a consensus gold‐standard in patients with cellulitis to improve research rigor

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