Patel Mitesh, Lee Siang Ing, Levell Nick J, Smart Peter, Kai Joe, Thomas Kim S, Leighton Paul
Division of Primary Care & National Institute for Health Research, School of Medicine, University of Nottingham, Nottingham, UK
Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK.
BMJ Open. 2020 Oct 14;10(10):e034692. doi: 10.1136/bmjopen-2019-034692.
To explore healthcare professionals (HCPs) experiences and challenges in diagnosing suspected lower limb cellulitis.
UK nationwide.
20 qualified HCPs, who had a minimum of 2 years clinical experience as an HCP in the national health service and had managed a clinical case of suspected cellulitis of the lower limb in the UK. HCPs were recruited from departments of dermatology (including a specialist cellulitis clinic), general practice, tissue viability, lymphoedema services, general surgery, emergency care and acute medicine. Purposive sampling was employed to ensure that participants included consultant doctors, trainee doctors and nurses across the specialties listed above. Participants were recruited through national networks, HCPs who contributed to the cellulitis priority setting partnership, UK Dermatology Clinical Trials Network, snowball sampling where participants helped recruit other participants and personal networks of the authors.
Primary outcome was to describe the key clinical features which inform the diagnosis of lower limb cellulitis. Secondary outcome was to explore the difficulties in making a diagnosis of lower limb cellulitis.
The presentation of lower limb cellulitis changes as the episode runs its course. Therefore, different specialties see clinical features at varying stages of cellulitis. Clinical experience is essential to being confident in making a diagnosis, but even among experienced HCPs, there were differences in the clinical rationale of diagnosis. A group of core clinical features were suggested, many of which overlapped with alternative diagnoses. This emphasises how the diagnosis is challenging, with objective aids and a greater understanding of the mimics of cellulitis required.
Cellulitis is a complex diagnosis and has a variable clinical presentation at different stages. Although cellulitis is a common diagnosis to make, HCPs need to be mindful of alternative diagnoses.
探讨医疗保健专业人员（HCPs）在诊断疑似下肢蜂窝织炎时的经验和挑战。
英国全国范围。
20名合格的HCPs，他们在国家医疗服务体系中至少有2年作为HCP的临床经验，且在英国处理过下肢疑似蜂窝织炎的临床病例。HCPs来自皮肤科（包括蜂窝织炎专科诊所）、全科医疗、组织存活、淋巴水肿服务、普通外科、急诊护理和急性医学科。采用目的抽样法以确保参与者包括上述各专科的顾问医生、实习医生和护士。参与者通过国家网络、参与蜂窝织炎优先事项设定伙伴关系的HCPs、英国皮肤病临床试验网络、参与者帮助招募其他参与者的滚雪球抽样以及作者的个人网络招募。
主要结果是描述有助于诊断下肢蜂窝织炎的关键临床特征。次要结果是探讨诊断下肢蜂窝织炎的困难。
随着病情发展，下肢蜂窝织炎的表现会发生变化。因此，不同专科在蜂窝织炎的不同阶段看到临床特征。临床经验对于做出诊断的信心至关重要，但即使在经验丰富的HCPs中，诊断的临床依据也存在差异。提出了一组核心临床特征，其中许多与其他诊断重叠。这强调了诊断具有挑战性，需要客观辅助手段以及对蜂窝织炎的模仿病症有更深入的了解。
蜂窝织炎是一个复杂的诊断，在不同阶段有不同的临床表现。虽然蜂窝织炎是一个常见的诊断，但HCPs需要留意其他诊断。
