LL cellulitis is one of the most common infections requiring hospital admission. About 30% of these are recurrent episodes. CVD predisposes to cellulitis treatment failure, both relapse and recurrence. This study aims to determine the rate of accuracy of diagnosis of concurrent CVD in patients presenting with LL cellulitis, the frequency of active management of the CVD and the impact on outcome on cellulitis treatment that active management of CVD makes.
Methods: The study was conducted in a large tertiary teaching hospital in two parts. A qualitative prospective diagnostic accuracy study was undertaken of LL cellulitis admissions over a 3 month period, to assess the accuracy of diagnosis of concurrent CVD in LL cellulitis admissions. Patients underwent an independent secondary assessment by experts, within 96 hours of admission to determine the presence of concurrent CVD. A review was undertaken of the admitting diagnosis, documentation and subsequent management. As well as the diagnostic accuracy study, a retrospective cohort study was conducted. This examined 200 patients with documented CVD and LL cellulitis, and assessed the impact of active CVD management on outcome of cellulitis.
In the prospective study, there were 59 admissions of LL cellulitis. Twenty (33.9%) patients were found to have concurrent CVD. Of these, only 5 (25%) of the cohort had CVD documented in the admitting diagnoses. In none of these was CEAP classification documented. In the retrospective cohort of patients, active CVD management during the admission, was independently associated with a significantly decreased likelihood of relapse (OR 0.25, 95% CI 0.07-0.95) and recurrence (OR 0.29, 95% CI 0.12-0.71). The use of compression therapy (OR 3. 34, 95% CI 1.55-7.20) greatly increased the likelihood of cellulitis treatment success. The proportion of patients with treatment success and compression therapy (73.8%, 45/61) was statistically higher than those without compression therapy (53.2%, 74/139).
This study shows that active management of CVD in the setting of an acute admission for LL cellulitis has a significant impact on patient outcome by increasing the chance of treatment success. We also showed that in great number of patients admitted with cellulitis, this important co-diagnosis is missed, resulting in preventable morbidity and cost.
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