Int J Intern Emerg Med | Volume 2, Issue 1 | Research Article | Open Access
Yaacov Esayag1, David Shemesh2, David Katz3, Ziv Dadon4, Amos M Yinnon3* and Gabriel Munter4
1Medical Observation Unit, Shaare Zedek Medical Center, Jerusalem, Israel
2Vascular Laboratory, Shaare Zedek Medical Center, Jerusalem, Israel
3Division of Internal Medicine, Shaare Zedek Medical Center, Jerusalem, Israel
4Department of Internal Medicine C, Shaare Zedek Medical Center, Jerusalem, Israel
*Correspondance to: Amos M Yinnon
Fulltext PDFBackground: Lower limb cellulitis shares many of the features of deep vein thrombosis. Venous Doppler ultrasound examination of the affected leg is frequently performed.
Aim: To estimate the incidence of deep vein thrombosis in intermediate to high risk patients with lower limb cellulitis.
Design: Prospective study of patients admitted for cellulitis.
Methods: We screened 372 patients sequentially admitted for lower limb cellulitis, out of which we enrolled all 68 patients above 18 years old who were hospitalized for 3 or more days and had at least intermediate risk for Deep Vein Thrombosis (DVT) by Wells' criteria. The operator of the Doppler duplex ultrasonography was blinded to patient characteristics, clinical course and Wells’ score.
Results: Of the 68 patients, we detected two patients with deep vein thrombosis (2.9%, 95% CI 0-6.8%), significantly lower than the expected 17% based on the Wells’ score (p<0.001). Three additional patients had Superficial Vein Thrombosis (SVT) (4.4%, 95% CI 0% to 9.2%). The number of patients to be tested in order to diagnose either DVT or SVT is 13 to 16. Four patients with either deep or superficial vein thrombosis required anticoagulation and only immobilization was identified as a significant risk factor (i.e., present in 100% versus 44% of un-treated patients, p<0.001).
Conclusion: In patients with cellulitis of the lower limb, the Wells’ score overestimates the risk for DVT. Ultrasonography should be limited to patients with high clinical suspicion of DVT and moderate-to-high risk estimation of DVT by Wells' criteria.
Cellulitis; Erysipelas; Deep vein thrombosis; Superficial vein thrombosis; Wells’ score; Doppler duplex ultrasound
Esayag Y, Shemesh D, Katz D, Dadon Z, Yinnon AM, Munter G. Venous Thrombosis in Patients Presenting with Cellulitis of the Lower Limbs. Intern J Intern Emerg Med. 2019;2(1):1019.