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Utility of Lower Extremity Doppler in Patients with Lower Extremity Cellulitis: A Need to Change the Practice?

Muhammad Zubair Afzal1, Mian Muhammad Saleh1, Syed Razvi1

  • 1From the Grand Rapids Medical Education Partners/Michigan State University Internal Medicine Residency, and Spectrum Health, Grand Rapids, Michigan.

Southern Medical Journal
|July 21, 2015
PubMed

Insights

Lower extremity cellulitis and deep vein thrombosis (DVT) share symptoms, leading to frequent unnecessary ultrasounds. DVT is rare in cellulitis patients without risk factors, suggesting Doppler ultrasound is often not needed.

Area of Science:

  • Medical diagnostics
  • Vascular medicine
  • Infectious disease

Background:

  • Lower extremity (LE) cellulitis and deep vein thrombosis (DVT) present with overlapping symptoms like erythema, swelling, and calf tenderness.
  • This diagnostic challenge frequently leads to the unnecessary use of LE Doppler ultrasounds for patients admitted with LE cellulitis.
  • Unwarranted ultrasounds increase healthcare costs and subject patients to procedures without clear benefit.

Purpose of the Study:

  • To determine the percentage of patients admitted with LE cellulitis who undergo Doppler ultrasound.
  • To ascertain the prevalence of DVT in patients diagnosed with LE cellulitis.

Main Methods:

  • A retrospective chart review was conducted for patients admitted with LE cellulitis between January 1, 2009, and June 30, 2013.
  • Data collected included the performance of Doppler ultrasounds and the presence or absence of DVT.
  • Risk factors for DVT were compared between patients with and without DVT.

Main Results:

  • Of 624 patients with LE cellulitis, 417 (66.8%) underwent Doppler ultrasound.
  • Only 25 patients (5.9%) were diagnosed with DVT.
  • Predictors for DVT included prior cerebrovascular accident, calf swelling, and history of thromboembolism.

Conclusions:

  • The concurrent incidence of DVT and LE cellulitis is infrequent.
  • LE Doppler ultrasound has a low yield in patients with LE cellulitis lacking specific DVT risk factors.
  • Doppler ultrasound is not a necessary component of the standard admission evaluation for LE cellulitis.
Abstract

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