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Misdiagnosed lower extremity cellulitis leads to unnecessary hospitalization

A large portion of patients who were admitted to the hospital with a misdiagnosis of lower extremity cellulitis did not require hospital admission and received unnecessary antibiotics, according to study results published in JAMA Dermatology.

Researchers conducted a cross-sectional study of 259 patients admitted from the ED with a diagnosis of lower extremity cellulitis between June 2010 and December 2012 at a large urban hospital.

Patients were classified as having cellulitis after being discharged with a diagnosis of cellulitis, while patients were considered to have pseudocellulitis if they were given an alternative diagnosis during the hospital course, on discharge, or within 30 days of discharge.

Hospitalization costs per year attributed to misdiagnosed lower extremity pseudocellulitis were calculated using national cost figures from the Medical Expenditure Panel Survey for 2010.

There were 180 patients (69.5%) classified as having cellulitis, while 79 patients (30.5%) were considered to have psudocellulitis, including 52 patients who were admitted primarily for the treatment of cellulitis.

The mean length of hospitalization for patients with pseudocellulitis was 4.8 days. All patients in the pseudocellulitis cohort received at least one IV antibiotic.

Based on the ultimate diagnosis, 44 of the 52 patients (84.6%) did not require hospitalization, while 48 (92.3%) would not have required any antibiotics.

“We estimate cellulitis misdiagnosis leads to 50,000 to 130,000 unnecessary hospitalizations and $195 million to $515 million in avoidable health care spending,” the researchers wrote.

Estimated inappropriate intervention for patients with misdiagnosed cellulitis resulted in nosocomial infections, Clostridium difficile infections and anaphylaxis, according to the researchers.

“Our study serves as a call to arms for improving the care of patients with suspected lower extremity cellulitis,” the researchers concluded. “A combination of systems improvement and further categorization of the biology of cellulitis may lead to a combination of clinical findings and biomarkers that will reduce incorrect diagnosis. It has been previously shown that dermatology consultation in the inpatient setting may be helpful in increasing diagnostic accuracy, and we are presently in the process of developing a predictive model for the assessment of possible cellulitis.” – by Bruce Thiel

Disclosure: The researchers report no relevant financial disclosures.