If you read the lay medical news, that\u2019s the question being posed, indirectly, to Emergency Physicians at large. Why, oh why, are you terrible at accurately diagnosing and hospitalizing patients for cellulitis:<\/p>\n
\u201cApproximately One-Third Of People Diagnosed With Cellulitis Do Not Actually Have It, Study Suggests.\u201d(HealthDay<\/a>)<\/p>\n And, if you believe the authors of the cited\u00a0article, cellulitis misdiagnosis leads to up to 130,000 unnecessary hospitalizations and $515M in avoidable healthcare costs, let alone the costs\u00a0of\u00a0various secondary harms.<\/p>\n Unfortunately, this well-covered indictment of our care of cellulitis comes from a not-so-reliable study: a retrospective evaluation of 259 patients hospitalized over a 2 year period. Of these patient charts reviewed, the authors felt as though 79 (30.5%) were misdiagnosed with cellulitis. The authors then plugged these numbers into their meandering cost calculations for unnecessary care, resulting in the numbers above.<\/p>\n The actual conclusions, however, bear no resemblance to the circulating headline. It is not \u201cone-third of people diagnosed with cellulitis\u201d \u2013 it is one-third of a narrowly defined cohort of hospitalized patients with lower extremity cellulitis. The misdiagnosis rate is based only on the shadowy shapes\u00a0discernible through chart review, with all its omissions and inaccuracies. I doubt the sort of complicated medical presentations common at a teaching facility and referral hospital are generalizable to the vast majority of the ~2.5 million annual ED visits for cellulitis, most of whom are probably more straightforward. Then, even their cost numbers are probably inflated by using the average cost of an “unnecessary” 4.3 day medical stay \u2013 $12,656.90 \u2013 generalized to their cohort.<\/p>\n In many instances, in the setting of diagnostic uncertainty, it is absolutely reasonable to err on the side of caution and treatment. I am not certain these authors’ interpretation of their narrow slice of the healthcare spectrum accurately reflects the larger reality. Amusingly, though, their article ends with the statement \u201cOur study serves as a call to arms for improving the care of patients with suspected lower extremity cellulitis.\u201d Their proposed solution? A Dermatology consult on every case<\/a> of suspected lower extremity cellulitis!<\/p>\n \u201cCosts and Consequences Associated With Misdiagnosed Lower Extremity Cellulitis\u201d If you read the lay medical news, that\u2019s the question being posed, indirectly, to Emergency Physicians at large. Why, oh why, are you terrible at accurately diagnosing and hospitalizing patients for cellulitis: \u201cApproximately One-Third Of People Diagnosed With Cellulitis Do Not Actually Have It, Study Suggests.\u201d(HealthDay) And, if you believe the authors of the cited\u00a0article, … Continue reading “Why Can\u2019t We Properly Identify Cellulitis?”<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":true,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"Would you believe Emergency Physicians misdiagnose cellulitis 30% of the time? 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\nhttp:\/\/jamanetwork.com\/journals\/jamadermatology\/fullarticle\/2578851<\/a><\/p>\n\n