Original article
Inpatient dermatology consultation aids diagnosis of cellulitis among hospitalized patients: A multi-institutional analysis

https://doi.org/10.1016/j.jaad.2014.11.012Get rights and content

Background

Given its nonspecific physical examination findings, accurately distinguishing cellulitis from a cellulitis mimicker (pseudocellulitis) is challenging.

Objective

We sought to investigate the national incidence of cellulitis misdiagnosis among inpatients.

Methods

We conducted a retrospective review of inpatient dermatology consultations at Massachusetts General Hospital, University of Alabama at Birmingham Medical Center, University of California Los Angeles Medical Center, and University of California San Francisco Medical Center in 2008. All consults requested for the evaluation of cellulitis were included. The primary outcomes were determining the incidence of cellulitis misdiagnosis, evaluating the prevalence of associated risk factors, and identifying common pseudocellulitides.

Results

Of the 1430 inpatient dermatology consultations conducted in 2008, 74 (5.17%) were requested for the evaluation of cellulitis. In all, 55 (74.32%) patients evaluated for cellulitis were given a diagnosis of pseudocellulitis. There was no statistically significant difference in the rate of misdiagnosis across institutions (P = .12). Patient demographics and associated risk factor prevalence did not statistically vary in patients given a diagnosis of cellulitis versus those with pseudocellulitis (P > .05).

Limitations

This study was unable to evaluate all patients admitted with cellulitis and was conducted at tertiary care centers, which may affect the generalizability of the results.

Conclusions

Cellulitis is commonly misdiagnosed in the inpatient setting. Involving dermatologists may improve diagnostic accuracy and decrease unnecessary antibiotic use.

Section snippets

Patient population

This retrospective study was approved by the institutional review boards at all participating institutions. All inpatient dermatology consultations conducted at Massachusetts General Hospital, University of Alabama at Birmingham Medical Center, University of California Los Angeles Medical Center, and University of California San Francisco Medical Center in 2008 were recorded. Each institution is staffed with 1 or more full-time inpatient dermatologists who evaluated each consult with a resident

Results

In 2008, 1430 inpatient dermatology consultations were conducted at Massachusetts General Hospital, University of Alabama at Birmingham Medical Center, University of California Los Angeles Medical Center, and University of California San Francisco Medical Center with approximately equal numbers of consults conducted at each institution (Table I). A total of 74 (5.17%) consults were for the evaluation of cellulitis. Across all institutions, the mean age of the cellulitis population was 56.20

Discussion

Past studies have demonstrated that accurately diagnosing cellulitis in both the inpatient and outpatient setting is clinically challenging. Bauer and Maroon6 conducted a retrospective analysis of inpatient dermatology consultations at a single institution and reported that 33% of the 21 patients who were consulted for the evaluation of cellulitis had an alternative diagnosis. In a prospective study at 2 institutions, David et al7 found that of 145 patients admitted with cellulitis, 28% of the

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Funding sources: None.

Conflicts of interest: None declared.

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