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J Am Acad Dermatol. 2018 Dec;79(6):1076-1080.e1. doi: 10.1016/j.jaad.2018.06.062. Epub 2018 Jul 10.

The ALT-70 predictive model outperforms thermal imaging for the diagnosis of lower extremity cellulitis: A prospective evaluation.

Author information

1
Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Tufts University School of Medicine, Boston, Massachusetts.
2
Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee.
3
Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
4
Loyola University, Chicago, Illinois.
5
Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: amostaghimi@bwh.harvard.edu.

Abstract

BACKGROUND:

We previously demonstrated that dermatology consultation substantially reduces the rates of misdiagnosis of cellulitis; however, broad implementation of dermatology consultation is impractical on account of 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 the ALT-70 predictive model 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 the ALT-70 predictive model, thermal imaging, and combination testing (ALT-70 predictive model plus thermal imaging).

RESULTS:

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

LIMITATIONS:

Single-center design may limit generalizability.

CONCLUSION:

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

KEYWORDS:

ALT-70; SSTI; cellulitis; lower extremity cellulitis; misdiagnosis; skin and soft-tissue infection; thermal imaging

PMID:
30003987
DOI:
10.1016/j.jaad.2018.06.062
[Indexed for MEDLINE]

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