More 1st year ID fellow pearls #IDTwitter #MedTwitter- a chat about dx of cellulitis! Last week, we discussed two clinical trials for prevention of recurrence- today, lets discuss ALT70, a scoring system for dx. (1/8)
Most cellulitis is strep or staph and a lot of folks seem comfortable with its tx- IDSA guidelines are helpful, especially Figure 1: academic.oup.com/cid/article/59… (2/8)
However, there are many mimickers of cellulitis- "pseudocellulitis". In one retrospective study of a year of Dermatology consults, half of all consults were ordered for evaluation of cellulitis and only 25% of pts were found to have true cellulitis (pubmed.ncbi.nlm.nih.gov/26089048/) (3/8)
In a cross-sectional study of 259 pts admitted from ED for cellulitis, 30% were misdiagnosed and 92% of those pts received unnecessary abx (pubmed.ncbi.nlm.nih.gov/27806170/). Cellulitis is tough! What tools do we have? (4/8)
ALT70 is a quick scoring system I found helpful (pubmed.ncbi.nlm.nih.gov/28215446/). 3 points if findings are Asymmetric, 1 point if pt has Leukocytosis >10k, 1 point if pt has Tachycardia >90 bpm, and 2 points if pt is older than 70. So 7 points is max on this scale. (5/8)
Based on the authors' model, pts scoring 2 or less have 83%+ likelihood of pseudocellulitis and pts scoring 5 or greater >82% likelihood of true cellulitis. It is recommended to get either an ID or Dermatology consult for pts scoring 3-4 as a tiebreaker! (6/8)
However, ALT70 is not perfect- a follow up study (I believe it has only been published as an abstract so far) suggests that when being applied in the ED, 4 may be a better cut off than 5 for suspicion of true cellulitis (jaad.org/article/S0190-…). (7/8)
Like many other diseases, scoring systems remain tools that are used in conjunction with our clinical judgement rather than to replace it. Does anyone else have any other tips when considering cellulitis versus pseudocellulitis? Feel free to add to this thread! (8/8)
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