Inpatient dermatology consultation aids diagnosis of cellulitis among hospitalized patients: A multi-institutional analysis
Inpatient dermatology consultation aids diagnosis of cellulitis among hospitalized patients: A multi-institutional analysis
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DOI：
10.1016/j.jaad.2014.11.012
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发表时间：
2015-07-01
影响因子：
13.8
通讯作者：
Kroshinsky, Daniela
中科院分区：
文献类型：
--
作者：
Strazzula, Lauren;Cotliar, Jonathan;Kroshinsky, Daniela
背景：鉴于其非特异性的体检结果，准确区分蜂窝织炎和蜂窝织炎模拟（假性蜂窝织炎）是具有挑战性的。目的：了解全国住院患者蜂窝织炎误诊率。方法：我们对2008年马萨诸塞州总医院、阿拉巴马大学伯明翰医学中心、加州大学洛杉矶医学中心和加州大学旧金山医学中心的住院皮肤科会诊进行回顾性分析。所有被要求评估蜂窝织炎的咨询人员都包括在内。主要结果是确定蜂窝织炎误诊的发生率，评估相关危险因素的患病率，并确定常见的假蜂窝织质。结果：在2008年进行的1430例住院皮肤科会诊中，74例（5.17%）被要求评估蜂窝织炎。总共有55例（74.32%）蜂窝织炎患者被诊断为假性蜂窝织炎。各机构误诊率差异无统计学意义（P = 0.12）。诊断为蜂窝织炎的患者与诊断为假性蜂窝织炎的患者的患者人口统计学特征和相关危险因素患病率无统计学差异（P < 0.05）。局限性：本研究无法评估所有蜂窝织炎入院的患者，并且是在三级保健中心进行的，这可能会影响结果的普遍性。结论：蜂窝织炎在住院时常被误诊。让皮肤科医生参与可以提高诊断的准确性，减少不必要的抗生素使用。
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.