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

Cellulitis is overdiagnosed in up to 36% of emergency department (ED) cases. Teledermatology has been proposed as a solution to reduce diagnostic misclassification yet there is a paucity of data supporting this approach.

To compare cellulitis diagnostic discordance, confidence and perceived difficulty of diagnosis between emergency medicine (EM); dermatology (Derm); and infectious diseases (ID) physicians using information available during teledermatology conditions.

We conducted a secondary analysis of adult patients presenting to the ED for an acute skin complaint of the lower extremity. A consensus panel of six acute care physicians independently reviewed cases and determined cellulitis diagnosis. We then compared diagnostic discordance, confidence, and perceived difficulty between the three specialties using chi-squared tests.

201 participants were included in this analysis. Diagnostic discordance did not vary significantly by specialty (Derm: 15.7%; EM: 12.9%; ID: 17.7%; p = 0.176). There were significant differences in the confidence of diagnosis with ID physicians being very certain 38% of the time compared to Derm, 19%, and EM, 17% (p < 0.001) and in ratings of difficulty with ID physicians rating the diagnosis as very easy in 35% of cases compared to Derm: 13%, and EM: 14% (p < 0.001).

Under conditions that replicate teledermatology, cellulitis diagnosis did not differ by specialty. These findings suggest that diagnostic acumen is not a primary driver of ED cellulitis overdiagnosis. Future research aimed at improving cellulitis diagnosis should focus on interventions and clinical tools that target reported barriers, such as diagnostic uncertainty and access to follow-up care.