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.

中文翻译：

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ALT-70预测模型在下肢蜂窝织炎的诊断方面胜过热成像：前瞻性评估

背景

我们先前证明，皮肤科咨询可大大降低蜂窝织炎的误诊率；但是，鉴于现有的执业方式和报销制度，广泛实施皮肤科咨询是不切实际的。同时，提高诊断准确性的努力最终达到了即时点工具，包括用于下肢蜂窝织炎和热成像的ALT-70预测模型。

客观的

要进行头对头比较，评估ALT-70预测模型和热成像在诊断下肢蜂窝织炎中的性能。

方法

我们从假定的下肢蜂窝织炎患者中收集了ALT-70和热成像数据，并比较了ALT-70预测模型，热成像和组合测试（ALT-70预测模型加热成像）的分类指标和准确性。

结果

我们招募了67例具有ALT-70和热成像数据的患者。ALT-70预测模型具有最高的敏感性（97.8％）和阴性预测值（90.9％），而联合检测具有最高的特异性（71.4％）和阳性预测值（86.6％）。与热成像相比，ALT-70预测模型具有改进的分类指标。与单独的ALT-70预测模型相比，组合测试具有边际收益。

局限性

单中心设计可能会限制一般性。

结论

在诊断下肢蜂窝织炎中，ALT-70预测模型优于热成像。ALT-70预测模型的准确性很高，并且与以前发表的文献中的表现一致。ALT-70预测模型在临床实践中的广泛实施可能会降低下肢蜂窝织炎的误诊率。