marcadro serico para celulitis.

The ALT-70 Predictive Model Outperforms Thermal Imaging for the Diagnosis of Lower Extremity Cellulitis

TAKE-HOME MESSAGE

• This prospective cohort study performed a head-to-head comparison of two currently available diagnostic tools for cellulitis: ALT-70 and thermal imaging. The ALT-70 model is specific to lower-extremity cellulitis and assigns points to asymmetry, leukocytosis, tachycardia, and age ≥70. Thermal imaging measures the skin temperature difference between the affected and unaffected sites in individuals with cellulitis using real-time infrared imaging. A total of 67 individuals with suspected cellulitis were evaluated using ALT-70, thermal imaging, and a combination of the two. ALT-70 had the highest sensitivity (97.8%) and negative predictive value (90.9%); combination testing had the highest specificity (71.4%) and positive predictive value (86.6%). Combination testing had a marginal benefit over ALT-70 alone.

• While both ALT-70 and thermal imaging may be used to refine diagnostic accuracy for presumed cellulitis, ALT-70 may be more accurate than thermal imaging. ALT-70 is an easy and consistent tool that can be integrated into clinical practice to reduce misdiagnosis rates, healthcare spending, and unnecessary care associated with lower-extremity cellulitis.

  – InYoung Kim, MD, PhD

Abstract:

BACKGROUND

We previously demonstrated dermatology consultation to substantially reduce cellulitis misdiagnosis rates; however, broad implementation is impractical due to existing practice patterns and reimbursement systems. Meanwhile, efforts to improve diagnostic accuracy have culminated in point-of-care tools, including the ALT-70 predictive model for lower extremity cellulitis and thermal imaging.

OBJECTIVE

To prospectively evaluate the performance of ALT-70 and thermal imaging in diagnosing lower extremity cellulitis in a head-to-head comparison.

METHODS

We collected ALT-70 and thermal imaging data from patients with presumed lower extremity cellulitis and compared classification measures and accuracy for ALT-70, thermal imaging, and combination testing (ALT-70 plus thermal imaging).

RESULTS

We enrolled 67 patients with ALT-70 and thermal imaging data. ALT-70 conferred the highest sensitivity (97.8%) and negative predictive value (90.9%), while combination testing had the highest specificity (71.4%) and positive predictive value (86.6%). ALT-70 had improved classification measures compared to thermal imaging. Combination testing conferred a marginal benefit to ALT-70 alone.

LIMITATIONS

Single-center design may limit generalizability.

CONCLUSION

ALT-70 outperformed thermal imaging in diagnosing lower extremity cellulitis. The accuracy of the ALT-70 was high and consistent with previously published reports. Broad implementation of ALT-70 into clinical practice may decrease misdiagnosis rates of lower extremity cellulitis.

Journal of the American Academy of Dermatology

The ALT-70 Predictive Model Outperforms Thermal Imaging for the Diagnosis of Lower Extremity Cellulitis: A Prospective Evaluation

J Am Acad Dermatol 2018 Jul 09;[EPub Ahead of Print], DG Li, AK Dewan, F Di Xia, H Khosravi, C Joyce, A Mostaghimi