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

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.