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Utilization of CT for Extremity Cellulitis: A Retrospective Single-Center Analysis.

Cynthia E Burke1, Owen R Maley2, Benjamin Mancini1

  • 1Penn State College of Medicine, Hershey, Pennsylvania.

Journal of the American College of Radiology : JACR
|November 3, 2024
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Summary
This summary is machine-generated.

Computed tomography (CT) scans for extremity cellulitis show a low yield for detecting deep infections. This imaging often fails to impact surgical decisions, suggesting overuse in this clinical scenario.

Keywords:
CTCellulitisutilization

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Area of Science:

  • Radiology
  • Infectious Diseases
  • Surgical Decision Making

Background:

  • Routine imaging for soft tissue infections is not recommended, yet computed tomography (CT) may be overused.
  • The clinical utility of CT in patients with superficial soft tissue infections of the extremities remains unclear.
  • Evaluating CT utilization and its impact in extremity cellulitis cases is crucial for optimizing patient care.

Purpose of the Study:

  • To assess the utilization and clinical impact of CT scans ordered for extremity cellulitis.
  • To determine the diagnostic yield of CT in identifying deep infections associated with cellulitis.
  • To analyze trends in CT utilization and its effectiveness over a 10-year period.

Main Methods:

  • Retrospective analysis of 496 patient encounters with extremity cellulitis who underwent CT between 2012 and 2021.
  • Collection of patient history, CT imaging characteristics, and surgical decision-making data.
  • Statistical evaluation using Rao-Scott chi-squared tests and logistic regression to assess CT yield and trends.

Main Results:

  • The yield of positive CT findings for deep infection in lower extremity cellulitis was 5.5%, significantly lower than the hypothesized 10%.
  • CT utilization increased from 0.08% to 0.14% per hospital visit between 2012-2013 and 2020-2021.
  • In 12.1% of encounters, surgery was performed, with only 21 cases preceded by a positive CT for deep infection.

Conclusions:

  • CT scans for extremity cellulitis demonstrate a low yield for detecting deep infections and have a limited impact on surgical management.
  • The high rate of patients undergoing multiple imaging studies indicates uncertainty in selecting appropriate diagnostic modalities.
  • This study suggests that CT may be overutilized in the evaluation of extremity cellulitis, prompting a re-evaluation of current imaging practices.