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"Clinically Useless" Tests for Cellulitis Cost Hundreds of Millions Each Year

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD

Patients with uncomplicated cellulitis frequently undergo blood culture and imaging, despite recommendations against routine use of such testing, finds a retrospective study in JAMA Internal Medicine. And the economic toll is significant.

Researchers examined the medical records of 183 patients seen at one emergency department with presumed uncomplicated cellulitis who were subsequently admitted. One third had blood cultures (with growth detected in 1 patient), but culture was deemed appropriate according to clinical guidelines in just 10% of the overall cohort. Additionally, nearly 70% underwent imaging (e.g., ultrasound, radiograph), and none of these tests were considered appropriate.

The researchers estimate that the national cost of "these largely clinically useless diagnostic studies" exceeds $225 million annually. They note that guidelines from the Infectious Diseases Society of America recommend against imaging unless patients also have febrile neutropenia, and against culture unless patients are severely immunocompromised, show systemic toxic effects, of have had an animal bite.

JAMA Internal Medicine research letter (Subscription required)

Background: NEJM Journal Watch Dermatology coverage of IDSA guidelines (Free)

Benjamin Hidalgo-Matlock

Skin Care Physicians of Costa Rica

4000-1054

2208-8206

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