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Weeding out cases of cellulitis misdiagnosis

Doctors in Florida see many patients with skin inflammation and other symptoms of skin disorders. One skin infection, cellulitis, is common, but there is no reliable tool for diagnosing it. Because its symptoms are similar to those of other skin conditions, many cellulitis diagnoses are false. Now researchers have found that involving a dermatologist in the diagnosis of cellulitis at an early stage can catch misdiagnoses and prevent unnecessary treatment.

Researchers at Brigham and Women's Hospital had previously discovered that approximately one-third of patients admitted to the hospital's emergency room had pseudocellulitis. This prompted an intervention in which a group of 165 patients who were presumed to have cellulitis were given a dermatology consultation prior to being admitted. One-third of those patients were diagnosed with pseudocellulitis. Dermatologists recommended stopping antibiotic treatment for 82.4 percent of those patients, and discharge from admission or observation for half of them. None of the discharged patients experienced any worsening of symptoms thereafter.

The researchers estimate that early consultation with a dermatologist in cases of presumed cellulitis could prevent as many as 256,000 days of hospitalization and up to 91,000 cases of unnecessary treatment with antibiotics. It could also save up to $210 million per year nationwide.While Brigham and Women's Hospital has arranged for dermatology consultation for patients with presumptive cellulitis, researchers say that doing this could present a challenge to nursing homes, doctor's offices or other medical facilities that do not have access to round-the-clock dermatology consultation.

A misdiagnosis could rise to the level of medical malpractice. An attorney for a harmed patient will have to demonstrate that the error constituted a failure to exercise the required standard of care.

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