Consultation with a dermatologist for presumptive cellulitis can improve patient outcomes, reduce costs and reduce unnecessary hospitalization.
Cellulitis - a bacterial infection of the skin - is a common medical condition, yet there is no diagnostic tool for it currently available. The only way to diagnose cellulitis is based on the appearance of the affected area and the patient's reported symptoms. Many other medical conditions cause skin inflammation that mimics the appearance of cellulitis (known as pseudocellulitis) and is commonly misdiagnosed.
A new study by researchers from Brigham and Women's Hospital demonstrates that early consultation by a dermatologist for patients with presumed cellulitis was a cost-effective intervention to prevent misdiagnoses and improve health-related outcomes.
Previous work by Mostaghimi and his colleagues evaluated a series of patients in BWH's Emergency Department with a presumptive diagnosis of cellulitis and determined that a third of these patients had pseudocellulitis.
Alarmed by this statistic, the dermatology consult team partnered with the inpatient group and ED to provide dermatology consultation for 165 patients in the ED observation unit who were about to be admitted with a presumptive diagnosis of cellulitis.
A third of these patients were diagnosed with pseudocellulitis by dermatology consultation. The dermatologists recommended the discontinuation of antibiotics in 82.4 percent of these patients, and discharge from planned observation or inpatient admissions in half of the patients. None of the patients diagnosed with pseudocellulitis showed worsening of their condition after discharge.
Extrapolating from their findings, the researchers estimate that dermatology consultation for presumed cellulitis could nationally prevent
- between 97,000 to 256,000 in hospitalization days
- 34,000 to 91,000 cases of unnecessary antibiotic exposure
- It could also result in $80 million to $210 million in net cost savings annually
Mostaghimi and his team are currently developing tools to allow them to provide high-quality dermatology consultation remotely, which they call "teledermatology," to improve health-related outcomes of pseudocellulitis diagnoses on a much larger scale.