Severe lower limb cellulitis is best diagnosed by dermatologists and managed with shared care between primary and secondary care

Levell, N. J.; Wingfield, Carrie; Garioch, J.

doi:10.1111/j.1365-2133.2011.10275.x

Cited by 118 publications

(101 citation statements)

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“…However, some of these patients may be misdiagnosed and may instead have stasis dermatitis, lipodermatosclerosis, or contact dermatitis as an example, and thus would not have responded to treatment with intravenous antibiotics. The distinction of cellulitis among its mimics is based primarily on morphological features, and several studies have highlighted challenges in diagnostic accuracy among physicians given the broad differential diagnosis for the red leg [11][12][13] . Coordinating follow-up care for candidates at higher risk of readmission with consultants who may aptly distinguish common mimics of LLC also has the potential to diminish direct and indirect costs associated with rehospitalization, while improving quality and satisfaction of care.…”

Section: Discussionmentioning

confidence: 99%

Clinical Factors Associated with Readmission among Patients with Lower Limb Cellulitis

et al. 2017

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Background: There is substantial allocation of resources directed towards evaluation and management of lower limb cellulitis (LLC) in the acute care setting. Readmission for LLC is poorly understood, and there is little evidence with which to identify patients at risk for readmission. Objective: To describe demographics, comorbidities, admission vital signs, and laboratory markers of infection among patients with LLC who are readmitted, and to investigate which among these factors is associated with readmission. Methods: A cross-sectional retrospective cohort study was performed at tertiary and community hospitals within a regional health care system in order to summarize readmission characteristics. Univariate and multivariate models were created to estimate the likelihood of independent variables being associated with LLC readmission. Results: The readmission rate was 11.2% with a median age of 68.6 years for the cohort. Increased age and subsidized insurance were associated with more frequent admissions. For every 10-year age increase, cellulitis subjects had a 14% increase in readmission odds (OR 1.14, CI 1.07-1.20). Patients with subsidized insurance had an almost twofold increased risk (OR 1.88, CI 1.42-2.50). Smoking, obesity, hypertension, diabetes mellitus, renal insufficiency, tachycardia, hypotension, leukocytosis, and neutrophilia were not more frequent in readmitted patients. Conclusions: Older age and subsidized insurance were associated with readmission whereas severity indicators for infection including abnormal vital signs and laboratory markers were not significantly associated. Factors other than severity of infection, such as socioeconomic factors, may influence clinical decisions related to readmission for LLC.

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Section: Discussionmentioning

confidence: 99%

Clinical Factors Associated with Readmission among Patients with Lower Limb Cellulitis

et al. 2017

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“…Levell et al reported that their dermatology-led cellulitis clinic for secondary care emergency admissions resulted in improved accuracy in initial diagnosis, increased diagnosis of other underlying skin conditions and increased savings in treating cellulitis. 15 As with fragility fracture care, where access to an orthogeriatrician is recognised to be best practice with improved care of a high risk and vulnerable patient group, so the care of patients with infection should have access to other specialties. 16 Copley et al showed that by instigating a multidisciplinary approach to the care of children with osteomyelitis, including infectious disease specialists, there was a significant decrease in length of stay, readmission rates and the number of antibiotic changes during treatment.…”

Section: Discussionmentioning

confidence: 99%

The burden of bone, native joint and soft tissue infections on orthopaedic emergency referrals in a city hospital

Howell

Parker

Tsitskaris

et al. 2016

annals

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INTRODUCTION Bone, native joint and soft tissue infections are frequently referred to orthopaedic units although their volume as a proportion of the total emergency workload has not been reported previously. Geographic and socioeconomic variation may influence their presentation. The aim of this study was to quantify the burden of such infections on the orthopaedic department in an inner city hospital, determine patient demographics and associated risk factors, and review our current utilisation of specialist services. METHODS All cases involving bone, native joint and soft tissue infections admitted under or referred to the orthopaedic team throughout 2012 were reviewed retrospectively. Prosthetic joint infections were excluded. RESULTS Almost 15% of emergency admissions and referrals were associated with bone, native joint or soft tissue infection or suspected infection. The cohort consisted of 169 patients with a mean age of 43 years (range: 1-91 years). The most common diagnosis was cellulitis/other soft tissue infection and the mean length of stay was 13 days. Two-thirds of patients (n=112, 66%) underwent an operation. Fifteen per cent of patients were carrying at least one blood borne virus, eleven per cent were alcohol dependent, fifteen per cent were using or had been using intravenous drugs and nine per cent were homeless or vulnerably housed. CONCLUSIONS This study has shown that a significant number of patients are admitted for orthopaedic care as a result of infection. These patients are relatively young, with multiple complex medical and social co-morbidities, and a long length of stay.

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“…2 In a clinic staffed by dermatologists that was specifically developed to assess and treat patients with presumptive severe lower limb cellulitis, 210 of 635 patients (33%) had a different disease instead, and among the 425 patients with genuine cellulitis, 28% had an underlying predisposing dermatologic condition that independently warranted therapy. 3 The most common conditions mistaken for cellulitis were eczema, lymphedema, and lipodermatosclerosis. Others have written about diseases that masquerade as cellulitis, which include lengthy lists of both common and uncommon disorders.…”

Section: E-mail Addresses Andmentioning

confidence: 99%

Lower limb cellulitis and its mimics

Hirschmann¹,

Raugi²

2012

Journal of the American Academy of Dermatology

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Severe lower limb cellulitis is best diagnosed by dermatologists and managed with shared care between primary and secondary care

Abstract: This new way of managing suspected lower limb cellulitis offered substantial savings for the NHS, and benefits of early and accurate diagnosis with correct home treatment for patients.

Cited by 118 publications

References 5 publications

Clinical Factors Associated with Readmission among Patients with Lower Limb Cellulitis

Clinical Factors Associated with Readmission among Patients with Lower Limb Cellulitis

The burden of bone, native joint and soft tissue infections on orthopaedic emergency referrals in a city hospital

Lower limb cellulitis and its mimics

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