_id

683a161cc782e11e38d1b1d9

id

3998

title

ALT-70 Score for Cellulitis

full_title

ALT-70 Score for Cellulitis

short_title

ALT-70 Score

med_description

Predicts likelihood of lower extremity cellulitis over other diagnoses.

short_description

Lower extremity cellulitis diagnosis.

slug

alt-70-score-cellulitis

description

The ALT-70 Score for Cellulitis predicts likelihood of lower extremity cellulitis over other diagnoses.

keywords

Alt 70, cellulitis score

complaint

[ "Extremity Edema", "Extremity Pain" ]

formula

Addition of the selected points:

evidence

measurements

[]

information

Interpretation:

refrences

{ "Clinical Practice Guidelines": [], "Manufacturer Website": [], "Original/Primary Reference": [ { "href": "https://www.jaad.org/article/S0190-9622(17)30018-X/abstract", "text": "Raff AB, Weng QY, Cohen JM, et al. A predictive model for diagnosis of lower extremity cellulitis: A cross-sectional study. J Am Acad Dermatol. 2017;76(4):618-625.e2." } ], "Other References": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/21564054", "text": "Levell NJ, Wingfield CG, Garioch JJ. Severe lower limb cellulitis is best diagnosed by dermatologists and managed with shared care between primary and secondary care. Br J Dermatol. 2011;164(6):1326-8." }, { "href": "https://www.ncbi.nlm.nih.gov/pubmed/25143179", "text": "Arakaki RY, Strazzula L, Woo E, Kroshinsky D. The impact of dermatology consultation on diagnostic accuracy and antibiotic use among patients with suspected cellulitis seen at outpatient internal medicine offices: a randomized clinical trial. JAMA Dermatol. 2014;150(10):1056-61." }, { "href": "https://www.ncbi.nlm.nih.gov/pubmed/26089048", "text": "Strazzula L, Cotliar J, Fox LP, et al. Inpatient dermatology consultation aids diagnosis of cellulitis among hospitalized patients: A multi-institutional analysis. J Am Acad Dermatol. 2015;73(1):70-5." }, { "href": "https://www.ncbi.nlm.nih.gov/pubmed/27434444", "text": "Raff AB, Kroshinsky D. Cellulitis: A Review. JAMA. 2016;316(3):325-37." }, { "href": "https://jamanetwork.com/journals/jamadermatology/fullarticle/2578851", "text": "Weng QY, Raff AB, Cohen JM, et al. Costs and Consequences Associated With Misdiagnosed Lower Extremity Cellulitis. JAMA Dermatol. 2016." }, { "href": "https://www.ncbi.nlm.nih.gov/pubmed/29453874", "text": "Li DG, Xia FD, Khosravi H, et al. Outcomes of Early Dermatology Consultation for Inpatients Diagnosed With Cellulitis. JAMA Dermatol. 2018;154(5):537-543." }, { "href": "https://www.ncbi.nlm.nih.gov/pubmed/29453872", "text": "Ko LN, Garza-mayers AC, St john J, et al. Effect of Dermatology Consultation on Outcomes for Patients With Presumed Cellulitis: A Randomized Clinical Trial. JAMA Dermatol. 2018;154(5):529-536." } ], "Outcomes": [], "Validation": [ { "href": "https://www.sciencedirect.com/science/article/pii/S0190962218322217", "text": "Li DG, Dewan AK, Di Xia F, Khosravi H, Joyce C, Mostaghimi A. The ALT-70 Predictive Model Outperforms Thermal Imaging for the Diagnosis of Lower Extremity Cellulitis: A Prospective Evaluation. J Am Acad Dermatol. 2018." }, { "href": "https://www.ncbi.nlm.nih.gov/pubmed/30914341", "text": "Singer S, Li DG, Gunasekera N, et al. The ALT-70 Predictive Model Maintains Predictive Value at 24 and 48 Hours after Presentation. J Am Acad Dermatol. 2019." } ], "Validations": [] }

pearls

• Developed to assist with evaluation of lower extremity redness, which may be inappropriately diagnosed as cellulitis (versus mimickers, or “pseudocellulitis”).  

• Most patients with cellulitis have acute onset, unilateral involvement (usually one leg), and are sick with an elevated white blood cell count, tachycardia, and/or a fever.

• Validated in a small cohort of 67 patients (Li 2018).

usecase

• Adult patients presenting to the ED with a red leg and clinical concern for cellulitis.

• Do not use if any of the following:

• Visible abscess/fluctuance.

• Penetrating trauma.

• Burn.

• Diabetic ulcer.

• Implanted hardware/device.

• Post-operative patient.

• Recent (within 48 hours) IV antibiotic use.

reasons

Cellulitis is the most common skin and soft tissue infection, with a high cost. No gold-standard diagnostic test exists, and clinical signs of redness, edema, warmth, and tenderness are nonspecific. At least 30% of patients with presumed cellulitis are misdiagnosed, leading to unnecessary admissions, overuse of antibiotics, and missed alternative diagnoses. Factors previously used to determine likelihood of true cellulitis (e.g. past medical and skin history, prior cellulitis, ulcers, barrier disruption, tinea, lymphedema, venous disease, malignancy, and underlying dermatitis) have not been shown to be statistically significant risk factors for cellulitis. May also help indicate appropriate subspecialty consultation to identify pseudocellulitis/mimickers.

next_advice

• Scores 5-7 indicate likely cellulitis (>82.2% likelihood), and patients should receive appropriate therapy. This may vary based on comorbidities or underlying diseases, history of resistant organisms, prior culture data or prior antibiotic use, and/or whether there is a clear trigger or portal of entry.

• Scores 3-4 indicate uncertainty, and consultation may be appropriate. Dermatology consultation may assist in the evaluation and can help identify alternative etiologies or explanations; if not available, ID consultation may be appropriate. Examples of alternative etiologies include:

• Vascular inflammation, stasis dermatitis.

• Inflammatory skin conditions.

• Alternate infections (e.g. Lyme).

• Chemotherapeutic reactions.

• Contact dermatitis.

• Scores 0-2 suggest patients are unlikely to have true cellulitis (likelihood of pseudocellulitis >83.3%) and should be reassessed to have the differential diagnosis reconsidered. Very common mimickers include:

• Bilateral redness without tachycardia/leukocytosis in a patient with edema and/or heart failure, suggestive of stasis dermatitis.

• Pruritic, geometric patch with serous drainage in someone using a topical agent who may have developed allergic contact dermatitis.

next_actions

• Patients with septic physiology may require more immediate attention and aggressive intervention.  

• Patients with fluctuant lesions/abscesses may require imaging and/or surgical intervention.

next_management

• Patients with true cellulitis should be treated with standard-of-care management, which varies based on their underlying disease state, recent antibiotics or previously documented microbial culture data, and local antibiotic resistant patterns.  This may include oral or IV antibiotics.

• Patients with pseudocellulitis (mimickers) should be treated appropriately for the identified alternate diagnosis.

diseases

[ "Cellulitis/Abscess" ]

input_schema

[ { "conditionality": "", "default": 0, "label_en": "Asymmetric", "md_calc_info_concept": null, "name": "asy", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 3 } ], "show_points": true, "tips_en": "", "type": "toggle" }, { "conditionality": "", "default": 0, "label_en": "Age ≥70 years", "md_calc_info_concept": null, "name": "age", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 2 } ], "show_points": true, "tips_en": "", "type": "toggle" }, { "conditionality": "", "default": 0, "label_en": "WBC in ED ≥10,000/µL", "md_calc_info_concept": null, "name": "wbc", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": true, "tips_en": "", "type": "toggle" }, { "conditionality": "", "default": 0, "label_en": "HR in ED ≥90 bpm", "md_calc_info_concept": null, "name": "hr", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": true, "tips_en": "", "type": "toggle" } ]

instructions

Use in adult patients presenting to the ED with a red leg and clinical concern for cellulitis. Do not use if: visible abscess/fluctuance, penetrating trauma, burn, diabetic ulcer, hardware/device, post-operative patient, or recent (within 48 hrs) IV antibiotic use.

published

2022-04-21T20:29:34.463Z

purpose

[ "Prognosis" ]

search_terms

[ "cellulitis score", "Alt 70" ]

seo

{ "keywords_en": "Alt 70, cellulitis score", "meta_description_en": "The ALT-70 Score for Cellulitis predicts likelihood of lower extremity cellulitis over other diagnoses." }

specialty

[ "Dermatology", "Family Practice", "Internal Medicine" ]

departments

[ "Dermatologic" ]

tags

[]

version_number

1

versions

[]

related

[ { "calcId": 10059, "short_title_en": "PEDIS Score", "slug": "pedis-score-diabetic-foot-ulcers" }, { "calcId": 10557, "short_title_en": "MAPS Score", "slug": "mayo-alliance-prognostic-system-maps-score" }, { "calcId": 10580, "short_title_en": "ISTH-SCC BAT", "slug": "isth-scc-bleeding-assessment-tool" } ]

ismed

true

section

[ "whenToUseViewed", "pearlsPitfallsViewed", "whyUseViewed", "nextStepsViewed", "evidenceViewed" ]

cleaned_departments

[ "dermatology" ]

cleaned_use

[ "Adult patients presenting to the ED with a red leg and clinical concern for cellulitis.", "Do not use if any of the following:", "Visible abscess/fluctuance.", "Penetrating trauma.", "Burn.", "Diabetic ulcer.", "Implanted hardware/device.", "Post-operative patient.", "Recent (within 48 hours) IV antibiotic use." ]

pub

false