UMEM Educational Pearls

Category: Infectious Disease

Title: Cellulitis--Does your patient really have it?

Keywords: cellulitis (PubMed Search)

Posted: 12/15/2016 by Michael Bond, MD (Emailed: 12/17/2016) (Updated: 12/17/2016)
Click here to contact Michael Bond, MD


Take home points:

  1. Cellulitis is overdiagnosed
  2. 1/3 of patients diagnosed with cellulitis in the ED are ultimately given a different diagnosis
  3. The most common final diagnoses are vascular or inflammatory conditions.
  4. The over treatment of cellulitis increases healthcare costs, increases risk of adverse reactions, and can contribute to the development of drug resistant organisms.


According to a recent article in JAMA Dermatology that looked at ~250 adults admitted through the ED they found that 31% did not have cellulitis, and 85% of those that were admitted for cellulitis did not require admission.
Extrapolating from national data, the authors estimated that 18,000–48,000 patients are misdiagnosed and admitted each year through EDs with suspected lower extremity cellulitis, at a cost of $195–$515 million, not including the cost of unnecessary antibiotics and complications.
So the next time you are looking at a patient with both legs that are red consider venous stasis changes as a possible diagnose, as bilateral lower extremity cellulits is as rare as seeing a Zebra in the US.
Check out the article here