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Gunasekera, Nicole

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Gunasekera

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Nicole

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Gunasekera, Nicole

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Author's Publications: search.filters.isAuthorOfPublication.c8f6c3c7-53fa-45cb-8ac6-2231cedb8364

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    Costs and Consequences Associated With Misdiagnosed Lower Extremity Cellulitis
    (American Medical Association (AMA), 2017) Weng, Qing Yu; Raff, Adam; Cohen, Jeffrey Marcus; Gunasekera, Nicole; Okhovat, Jean-Phillip; Vedak, Priyanka; Joyce, Cara; Kroshinsky, Daniela; Mostaghimi, Arash
    Question What is the national health care burden of misdiagnosed lower extremity cellulitis in patients admitted to the hospital from the emergency department? Findings In this cross-sectional study that included 259 patients, 30% were misdiagnosed with cellulitis, of which 85% did not require hospitalization and 92% received unnecessary antibiotics. Combining these findings with previously published data, cost estimates, and and projections indicate that cellulitis misdiagnosis leads to 50 000 to 130 000 unnecessary hospitalizations in the United States and $195 million to $515 million in avoidable health care spending annually. Meaning Misdiagnosis of lower extremity cellulitis is common and may lead to unnecessary patient morbidity and considerable health care spending.
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    A predictive model for diagnosis of lower extremity cellulitis: A cross-sectional study
    (Elsevier BV, 2017) Raff, Adam; Weng, Qing Yu; Cohen, Jeffrey M.; Gunasekera, Nicole; Okhovat, Jean-Phillip; Vedak, Priyanka; Joyce, Cara; Kroshinsky, Daniela; Mostaghimi, Arash
    Background Cellulitis has many clinical mimickers (pseudocellulitis), which leads to frequent misdiagnosis. Objective To create a model for predicting the likelihood of lower extremity cellulitis. Methods A cross-sectional review was performed of all patients admitted with a diagnosis of lower extremity cellulitis through the emergency department at a large hospital between 2010 and 2012. Patients discharged with diagnosis of cellulitis were categorized as having cellulitis, while those given an alternative diagnosis were considered to have pseudocellulitis. Bivariate associations between predictor variables and final diagnosis were assessed to develop a 4-variable model. Results In total, 79 (30.5%) of 259 patients were misdiagnosed with lower extremity cellulitis. Of the variables associated with true cellulitis, the 4 in the final model were asymmetry (unilateral involvement), leukocytosis (white blood cell count ≥10,000/uL), tachycardia (heart rate ≥90 bpm), and age ≥70 years. We converted these variables into a points system to create the ALT-70 cellulitis score as follows: Asymmetry (3 points), Leukocytosis (1 point), Tachycardia (1 point), and age ≥70 (2 points). With this score, 0-2 points indicate ≥83.3% likelihood of pseudocellulitis, and ≥5 points indicate ≥82.2% likelihood of true cellulitis. Limitations Prospective validation of this model is needed before widespread clinical use. Conclusion Asymmetry, leukocytosis, tachycardia, and age ≥70 are predictive of lower extremity cellulitis. This model might facilitate more accurate diagnosis and improve patient care.