The ALT-70 predictive model outperforms thermal imaging for the diagnosis of lower extremity cellulitis: A prospective evaluation - 10/11/18
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.
Il testo completo di questo articolo è disponibile in PDF.Key words : ALT-70, cellulitis, lower extremity cellulitis, misdiagnosis, skin and soft-tissue infection, SSTI, thermal imaging
Abbreviations used : PPV, NPV, ROC
Mappa
| Funding sources: Supported by the TL1 Award (to Mr Li) sponsored by the National Center for Advancing Translational Sciences, National Institutes of Health (award No. TL1TR001062) and the Brigham and Women's Physician Organization Brigham Care Redesign Incubator and Startup Program (to Dr Mostaghimi). |
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| Conflicts of interest: None disclosed. |
Vol 79 - N° 6
P. 1076 - dicembre 2018 Ritorno al numero
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