Comparing Cellulitis Diagnostic Accuracy Between Emergency Physicians and Dermatologists Under Teledermatology...

Area of Science:

• Dermatology
• Infectious Diseases
• Emergency Medicine
• Teledermatology

Background:

• Cellulitis is frequently overdiagnosed in emergency departments (EDs), with misdiagnosis rates up to 36%.
• Teledermatology offers a potential solution for diagnostic misclassification, but supporting data is limited.

Purpose of the Study:

• To compare diagnostic discordance, confidence, and perceived difficulty in diagnosing cellulitis among emergency medicine (EM), dermatology (Derm), and infectious diseases (ID) physicians.
• To evaluate these diagnostic parameters under simulated teledermatology conditions.

Main Methods:

• Secondary analysis of adult patients presenting to the ED with lower extremity skin complaints.
• Independent review of cases by a consensus panel of six acute care physicians to determine cellulitis diagnosis.
• Comparison of diagnostic discordance, confidence, and difficulty ratings across EM, Derm, and ID specialties using chi-squared tests.

Main Results:

• Diagnostic discordance did not significantly differ by specialty (Derm: 15.7%, EM: 12.9%, ID: 17.7%; p=0.176).
• Infectious diseases physicians reported higher confidence (38%) and perceived ease (35%) compared to dermatology (19%, 13%) and EM (17%, 14%) physicians (p<0.001).

Conclusions:

• Cellulitis diagnosis did not vary significantly by specialty under teledermatology conditions.
• Diagnostic skill is unlikely the primary cause of ED cellulitis overdiagnosis.
• Future interventions should address diagnostic uncertainty and access to follow-up care to improve cellulitis diagnosis.