How can the diagnostic accuracy of lower limb cellulitis be improved?

Patel, Mitesh (2022) How can the diagnostic accuracy of lower limb cellulitis be improved? Doctoral thesis, University of East Anglia.

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Lower limb cellulitis (cellulitis) affects 1 in 40 people annually in the United Kingdom. However, misdiagnosis is common: approximately a third of those presenting with a red leg and initially managed as cellulitis turn out to have other diagnoses. Incorrect diagnoses lead to inappropriate hospital admissions and antibiotic prescribing.

How to improve the diagnostic accuracy of cellulitis is therefore imperative, and a key research priority from the James Lind Alliance cellulitis priority setting partnership.

The main aim of this thesis was to explore how the diagnosis of cellulitis can be improved.

A scoping review and interview studies with health care professionals and people with cellulitis were undertaken to help to identify the key challenges in diagnosing cellulitis. A systematic review to identify diagnostic tools developed for cellulitis was performed. The interview study with health care professionals also identified key clinical features for future diagnostic tools.

The key challenges in diagnosing cellulitis centred on three themes: 1) clinical presentation (subthemes: vague early symptoms, overlapping core features, unclear typical features in certain groups); 2) clinical reasoning (subthemes: specific diagnostic tests, subjectivity, strategic decision making); and 3) learning and education.

The systematic review identified six different diagnostic tools from eleven studies: a biochemical marker, diagnostic criterion, a diagnostic decision support system, a diagnostic predictive model, thermal imaging and light imaging. All studies were considered to have a high risk of bias in at least one domain.
Health care professionals identified key clinical features for a cellulitis diagnosis, which could be considered for inclusion in future diagnostic tools.

Despite a third of suspected cellulitis presentations being misdiagnosed, the solutions to improve the diagnostic accuracy of cellulitis remain limited. This thesis has highlighted the challenges in diagnosing cellulitis and has identified emerging diagnostic tools warranting further investigation.

Item Type: Thesis (Doctoral)
Uncontrolled Keywords: Publication
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User: Chris White
Date Deposited: 23 Feb 2023 13:14
Last Modified: 23 Feb 2023 13:14


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