Cellulitis is a common bacterial skin infection that leads to 2.9 million emergency department visits annually in the United States. Although it is a common condition, our research has demonstrated that one of three cases of cellulitis is misdiagnosed, leading to unnecessary hospitalizations, antibiotic use, and increased health care spending and healthcare costs.

To help reduce misdiagnosis, we have created and validated the ALT-70, a simple scoring system for point-of-care decision support when considering a diagnosis of lower extremity cellulitis for patients in the emergency department. We’ve subsequently validated the performance of the ALT-70 at 24 and 48 hours after presentation, and compared its efficacy to diagnostic support with thermal imaging. You can test the ALT-70 on MDCalc: https://www.mdcalc.com/alt-70-score-cellulitis.

We have also shown that early dermatology consultation is a cost-effective method to prevent the misdiagnosis of cellulitis and improve health-related outcomes for patients.

Selected Publications:

Singer S, Li DG, Gunasekera N, et al. The ALT-70 cellulitis model maintains predictive value at 24 and 48 hours after presentation. Journal of the American Academy of Dermatology. 2019;81(6):1252-1256.

Li DG, Joyce C, Mostaghimi A. Patient factors associated with nationwide emergency department utilization for cellulitis. The American journal of emergency medicine. 2019;37(2):361-363.

Korman AM, Kroshinsky D, Raff AB, et al. A survey-based study of diagnostic and treatment concordance in standardized cases of cellulitis and pseudocellulitis via teledermatology. Journal of the American Academy of Dermatology. 2019.

Fisher JM, Feng JY, Tan SY, Mostaghimi A. Analysis of Readmissions Following Hospitalization for Cellulitis in the United States. JAMA dermatology. 2019;155(6):720-723.

Li DG, Xia FD, Khosravi H, et al. Outcomes of Early Dermatology Consultation for Inpatients Diagnosed With Cellulitis. JAMA dermatology. 2018;154(5):537-543.

Li DG, Krajewski KM, Mostaghimi A. Mass Compression from Recurrent Lymphoma Mimicking Lower Extremity Cellulitis. Cureus. 2018;10(4):e2466.

Li DG, Dewan AK, Xia FD, Khosravi H, Joyce C, Mostaghimi A. The ALT-70 predictive model outperforms thermal imaging for the diagnosis of lower extremity cellulitis: A prospective evaluation. Journal of the American Academy of Dermatology. 2018;79(6):1076-1080.e1071.

Weng QY, Raff AB, Cohen JM, et al. Costs and Consequences Associated With Misdiagnosed Lower Extremity Cellulitis. JAMA dermatology. 2017;153(2):141-146.

Raff AB, Weng QY, Cohen JM, et al. A predictive model for diagnosis of lower extremity cellulitis: A cross-sectional study. Journal of the American Academy of Dermatology. 2017;76(4):618-625.e612.

Mostaghimi lab

Department of Dermatology

Brigham and Women’s Hospital

Boston, MA, 02215