Cellulitis Often Misdiagnosed in ED

By Kelly Young

Edited by Susan Sadoughi, MD, and Richard Saitz, MD, MPH, FACP, FASAM

Cellulitis is often misdiagnosed in the emergency department, leading to unnecessary healthcare spending, suggests a JAMA Dermatology study.

Of roughly 250 adults admitted through an ED with presumed cellulitis of the lower extremities, 31% were ultimately given a different diagnosis within 30 days of discharge. The most common misdiagnoses were vascular or inflammatory conditions. Roughly two-thirds of the misdiagnosed patients were admitted primarily for cellulitis. All of these misdiagnosed patients received at least one IV antibiotic. Further review indicated that, had these patients been correctly diagnosed, 85% would not have required admission.

Using national data from 2010, the authors estimate that 18,000–48,000 patients admitted each year through EDs with suspected lower extremity cellulitis are misdiagnosed, at a cost of $195–$515 million, not including the cost of unnecessary antibiotics and complications.

The authors conclude: "Our study serves as a call to arms for improving the care of patients with suspected lower extremity cellulitis ... 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."