A predictive model for diagnosis of lower extremity cellulitis: A cross-sectional study Journal Article


Authors: Raff, A. B.; Weng, Q. Y.; Cohen, J. M.; Gunasekera, N; Okhovat, J. P.; Vedak, P; Joyce, C; Kroshinsky, D; Mostaghimi, A
Article Title: A predictive model for diagnosis of lower extremity cellulitis: A cross-sectional study
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 gt;/=10,000/uL), tachycardia (heart rate gt;/=90 bpm), and age gt;/=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 gt;/=70 (2 points). With this score, 0-2 points indicate gt;/=83.3% likelihood of pseudocellulitis, and gt;/=5 points indicate gt;/=82.2% likelihood of true cellulitis. LIMITATIONS: Prospective validation of this model is needed before widespread clinical use. CONCLUSION: Asymmetry, leukocytosis, tachycardia, and age gt;/=70 are predictive of lower extremity cellulitis. This model might facilitate more accurate diagnosis and improve patient care.
Keywords: Aged; Female; Humans; Middle Aged; Public Health Sciences; Male; Severity of Illness Index; Diagnosis, Differential; Age Factors; Public Health; Predictive Value of Tests; Cross-Sectional Studies; Sensitivity and Specificity; Diagnosis; Diagnostic Errors; Leg; Models, Theoretical; Cellulitis; Bacteremia/etiology; Cellulitis/complications/diagnosis; Emergencies; Leukocytosis/etiology; Tachycardia/etiology; diagnostic model; lower extremity cellulitis; misdiagnosis; predictive model; pseudocellulitis
Journal Title: Journal of the American Academy of Dermatology
Volume: 76
Issue: 4
ISSN: 1097-6787; 0190-9622
Publisher: American Academy of Dermatology, Inc. Published by Elsevier Inc  
Journal Place: United States
Date Published: 2017
Start Page: 618
End Page: 625.e2
Language: eng
DOI/URL:
Notes: LR: 20170425; CI: Copyright (c) 2017; JID: 7907132; OTO: NOTNLM; 2016/10/21 [received]; 2016/11/30 [revised]; 2016/12/23 [accepted]; ppublish