Diagnosis and management of cellulitis

Sullivan, Tadhg; Barra, Eoghan de

doi:10.7861/clinmedicine.18-2-160

Cited by 77 publications

(56 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A total of 98 papers were included for full‐text screening . Of these, 90 papers were subsequently excluded, including 20 studies that did not specify the site of cellulitis…”

Section: Resultsmentioning

confidence: 99%

A systematic review showing the lack of diagnostic criteria and tools developed for lower‐limb cellulitis

et al. 2019

View full text Add to dashboard Cite

SummaryBackgroundCellulitis can be a difficult diagnosis to make. Furthermore, 31% of patients admitted from the emergency department with suspected lower‐limb cellulitis have been misdiagnosed, with incorrect treatment potentially resulting in avoidable hospital admission and the prescription of unnecessary antibiotics.ObjectivesWe sought to identify diagnostic criteria or tools that have been developed for lower‐limb cellulitis.MethodsWe conducted a systematic review using Ovid MEDLINE and Embase databases in May 2018, with the aim of describing diagnostic criteria and tools developed for lower‐limb cellulitis, and we assessed the quality of the studies identified using the Quality Assessment of Diagnostic Accuracy Studies‐2 tool. We included all types of study that described diagnostic criteria or tools.ResultsEight observational studies were included. Five studies examined biochemical markers, two studies assessed imaging and one study developed a diagnostic decision model. All eight studies were considered to have a high risk for bias in at least one domain. The quantity and quality of available data was low and results could not be pooled owing to the heterogeneity of the findings.ConclusionsThere is a lack of high‐quality publications describing criteria or tools for diagnosing lower‐limb cellulitis. Future studies using prospective designs, validated in both primary and secondary care settings, are needed. What's already known about this topic? Diagnosing lower‐limb cellulitis on first presentation is challenging.Approximately one in three patients admitted from the emergency department with suspected lower‐limb cellulitis do not have cellulitis and are given another diagnosis on discharge. Consequently, this results in potentially avoidable hospital admissions and the prescription of unnecessary antibiotics.There are no diagnostic criteria available for lower‐limb cellulitis in the U.K. What does this study add? This systematic review has identified a key research gap in the diagnosis of lower‐limb cellulitis.There is a current lack of robustly developed and validated diagnostic criteria or tools for use in clinical practice.

show abstract

“…A total of 98 papers were included for full‐text screening . Of these, 90 papers were subsequently excluded, including 20 studies that did not specify the site of cellulitis…”

Section: Resultsmentioning

confidence: 99%

A systematic review showing the lack of diagnostic criteria and tools developed for lower‐limb cellulitis

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Two or more episodes of cellulitis diagnosed in the same leg in the past 2 years (at the time of referral). Clinical diagnosis of cellulitis ideally will have been based on the presence of acute erythema, oedema, warmth and pain, with spreading involvement of the skin and subcutaneous tissues, malaise and possibly fever 1 22 23…”

Section: Methodsmentioning

confidence: 99%

Impact of Compression Therapy on Cellulitis (ICTOC) in adults with chronic oedema: a randomised controlled trial protocol

et al. 2019

View full text Add to dashboard Cite

IntroductionCellulitis represents a significant burden to patients’ quality of life (QOL) and cost to the healthcare system, especially due to its recurrent nature. Chronic oedema is a strong risk factor for both an initial episode of cellulitis and cellulitis recurrence. Expert consensus advises compression therapy to prevent cellulitis recurrence in individuals with chronic oedema, however, there is little supporting evidence. This research aims to determine if the management of chronic oedema using compression therapy effectively delays the recurrence of lower limb cellulitis.Methods and analysisA randomised controlled trial with cross-over will be used to assess the impact of compression therapy on clinical outcomes (time to next episode of cellulitis, rate of cellulitis-related hospital presentations, QOL and leg volume). Using concealed allocation, 162 participants will be randomised into the intervention (compression) or control (no compression) group. Randomisation will be stratified by prophylactic antibiotic use. Participants will be followed up at 6 monthly intervals for up to 3 years or until 45 episodes of cellulitis occur across the cohort. Following an episode of recurrent cellulitis, control group participants will cross-over to the intervention group. Survival analysis will be undertaken to assess the primary outcome measure of time to cellulitis recurrence. The hypotheses are that compression therapy to control lower limb chronic oedema will delay recurrent lower limb cellulitis, reduce the rate of associated hospitalisations, minimise affected limb volume and improve the QOL of this population.Ethics and disseminationEthics approval has been obtained from the ethics committees of all relevant institutions. Results will be disseminated through relevant peer-reviewed journal articles and conference presentations.Trial registration numberACTRN12617000412336; Pre-results. The ICTOC trial is currently in progress. Participant recruitment started in May 2017 and is expected to continue until December 2019.

show abstract

“…There was little in this patient's history or physical examination to suggest any serious pathology. One of the differential diagnoses was cellulitis of the left upper leg, but the onset and lack of common features of cellulitis, such as redness, pain, swelling, and heat, made it very unlikely [5].…”

Section: Differential Diagnosismentioning

confidence: 99%

A Nearly Missed Pancoast Tumour From Isolated Persistent Leg Pain

Issa¹,

Abadin²

2021

Cureus

View full text Add to dashboard Cite

show abstract

Diagnosis and management of cellulitis

Abstract: Cellulitis is a frequently encountered condition, but remains a challenging clinical entity. Under and overtreatment with antimicrobials frequently occurs and mimics cloud the diagnosis. Typical presentation, microbiology and management approaches are discussed.

Cited by 77 publications

References 23 publications

A systematic review showing the lack of diagnostic criteria and tools developed for lower‐limb cellulitis

A systematic review showing the lack of diagnostic criteria and tools developed for lower‐limb cellulitis

Impact of Compression Therapy on Cellulitis (ICTOC) in adults with chronic oedema: a randomised controlled trial protocol

A Nearly Missed Pancoast Tumour From Isolated Persistent Leg Pain

Contact Info

Product

Resources

About