Patel M, Lee S I, Akyea R K, Grindlay D, Francis N, Levell N J, Smart P, Kai J, Thomas K S
Division of Primary Care & National Institute for Health Research, School of Medicine, University of Nottingham, Nottingham, U.K.
Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K.
Br J Dermatol. 2019 Dec;181(6):1156-1165. doi: 10.1111/bjd.17857. Epub 2019 Jun 28.
Cellulitis can be a difficult diagnosis to make. Furthermore, 31% of patients admitted from the emergency department with suspected lower-limb cellulitis have been misdiagnosed, with incorrect treatment potentially resulting in avoidable hospital admission and the prescription of unnecessary antibiotics.
We sought to identify diagnostic criteria or tools that have been developed for lower-limb cellulitis.
We conducted a systematic review using Ovid MEDLINE and Embase databases in May 2018, with the aim of describing diagnostic criteria and tools developed for lower-limb cellulitis, and we assessed the quality of the studies identified using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. We included all types of study that described diagnostic criteria or tools.
Eight observational studies were included. Five studies examined biochemical markers, two studies assessed imaging and one study developed a diagnostic decision model. All eight studies were considered to have a high risk for bias in at least one domain. The quantity and quality of available data was low and results could not be pooled owing to the heterogeneity of the findings.
There is a lack of high-quality publications describing criteria or tools for diagnosing lower-limb cellulitis. Future studies using prospective designs, validated in both primary and secondary care settings, are needed. What's already known about this topic? Diagnosing lower-limb cellulitis on first presentation is challenging. Approximately one in three patients admitted from the emergency department with suspected lower-limb cellulitis do not have cellulitis and are given another diagnosis on discharge. Consequently, this results in potentially avoidable hospital admissions and the prescription of unnecessary antibiotics. There are no diagnostic criteria available for lower-limb cellulitis in the U.K. What does this study add? This systematic review has identified a key research gap in the diagnosis of lower-limb cellulitis. There is a current lack of robustly developed and validated diagnostic criteria or tools for use in clinical practice.
蜂窝织炎可能难以诊断。此外，因疑似下肢蜂窝织炎而从急诊科收治的患者中，有31%被误诊，不正确的治疗可能导致不必要的住院以及不必要抗生素的处方。
我们试图确定已开发出的用于诊断下肢蜂窝织炎的诊断标准或工具。
我们于2018年5月使用Ovid MEDLINE和Embase数据库进行了一项系统评价，目的是描述已开发出的用于诊断下肢蜂窝织炎的诊断标准和工具，并使用诊断准确性研究质量评估-2工具评估所纳入研究的质量。我们纳入了所有描述诊断标准或工具的研究类型。
纳入了8项观察性研究。5项研究检测了生化标志物，2项研究评估了影像学，1项研究建立了诊断决策模型。所有8项研究在至少一个领域被认为存在高偏倚风险。现有数据的数量和质量较低，由于研究结果的异质性，无法进行数据合并。
缺乏描述诊断下肢蜂窝织炎的标准或工具的高质量出版物。未来需要采用前瞻性设计并在初级和二级医疗环境中均得到验证的研究。关于该主题已知的情况是什么？初次就诊时诊断下肢蜂窝织炎具有挑战性。因疑似下肢蜂窝织炎从急诊科收治的患者中，约三分之一实际上并非蜂窝织炎，出院时被给予了其他诊断。因此，这导致了潜在的不必要住院以及不必要抗生素的处方。在英国，尚无用于诊断下肢蜂窝织炎的诊断标准。本研究补充了什么？这项系统评价确定了下肢蜂窝织炎诊断方面的一个关键研究空白。目前缺乏在临床实践中充分开发和验证的诊断标准或工具。
