Cynthia E. Burke BS , Owen R. Maley MD , Benjamin Mancini BS , SaraPettey Sandifer BS , Sahil Sardesai BS , Tonya S. King PhD , Donald J. Flemming MD
{"title":"四肢蜂窝组织炎的计算机断层扫描应用：单中心回顾性分析。","authors":"Cynthia E. Burke BS , Owen R. Maley MD , Benjamin Mancini BS , SaraPettey Sandifer BS , Sahil Sardesai BS , Tonya S. King PhD , Donald J. Flemming MD","doi":"10.1016/j.jacr.2024.10.011","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><div>Routine imaging of soft tissue infection is not recommended and represents a potential area of CT overuse. The utility of CT in patients with superficial soft tissue infection of the extremities is unknown. The purpose of this study is to evaluate the utilization and clinical impact of CT ordered in the setting of extremity cellulitis.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed patients with extremity cellulitis examined with CT between 2012 and 2021 at a single center. We collected patient history, diagnostic imaging characteristics, and subsequent surgery decision. We hypothesized that yield of CT for deep infection was significantly lower than 10% and that yield was decreasing over time. These hypotheses were evaluated with Rao-Scott χ<sup>2</sup> tests and repeated measures logistic regression.</div></div><div><h3>Results</h3><div>There were 496 eligible encounters among 463 patients. Yield of positive CT among lower extremity patients was 5.5% (95% confidence interval 3.33-7.75), significantly less than our hypothesis of 10% (<em>P</em> = .003). In 71.8% of encounters, patients underwent diagnostic imaging studies in addition to CT. Utilization rose from 0.08% per hospital visit in 2012 to 2013 to 0.14% in 2020 to 2021, with differences in yield between time periods not reaching statistical significance (<em>P</em> = .059). Among 496 encounters, 62 received surgery (12.1%), with 21 of these cases preceded by a positive CT for deep infection.</div></div><div><h3>Conclusions</h3><div>Our 10-year single-center analysis of CT use for extremity cellulitis demonstrated a low yield of positive CT findings for deep infection and limited impact of CT on surgical management. A high incidence of patients undergoing multiple radiologic examinations suggests uncertainty in selecting appropriate imaging modalities in this clinical scenario.</div></div><div><h3>Summary</h3><div>This single-center retrospective analysis found that CT examination of patients with clinically diagnosed cellulitis of the extremities has significantly low yield for deep infection in the lower extremities.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 1","pages":"Pages 76-83"},"PeriodicalIF":4.0000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Utilization of CT for Extremity Cellulitis: A Retrospective Single-Center Analysis\",\"authors\":\"Cynthia E. Burke BS , Owen R. Maley MD , Benjamin Mancini BS , SaraPettey Sandifer BS , Sahil Sardesai BS , Tonya S. King PhD , Donald J. Flemming MD\",\"doi\":\"10.1016/j.jacr.2024.10.011\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Purpose</h3><div>Routine imaging of soft tissue infection is not recommended and represents a potential area of CT overuse. The utility of CT in patients with superficial soft tissue infection of the extremities is unknown. The purpose of this study is to evaluate the utilization and clinical impact of CT ordered in the setting of extremity cellulitis.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed patients with extremity cellulitis examined with CT between 2012 and 2021 at a single center. We collected patient history, diagnostic imaging characteristics, and subsequent surgery decision. We hypothesized that yield of CT for deep infection was significantly lower than 10% and that yield was decreasing over time. These hypotheses were evaluated with Rao-Scott χ<sup>2</sup> tests and repeated measures logistic regression.</div></div><div><h3>Results</h3><div>There were 496 eligible encounters among 463 patients. Yield of positive CT among lower extremity patients was 5.5% (95% confidence interval 3.33-7.75), significantly less than our hypothesis of 10% (<em>P</em> = .003). In 71.8% of encounters, patients underwent diagnostic imaging studies in addition to CT. Utilization rose from 0.08% per hospital visit in 2012 to 2013 to 0.14% in 2020 to 2021, with differences in yield between time periods not reaching statistical significance (<em>P</em> = .059). Among 496 encounters, 62 received surgery (12.1%), with 21 of these cases preceded by a positive CT for deep infection.</div></div><div><h3>Conclusions</h3><div>Our 10-year single-center analysis of CT use for extremity cellulitis demonstrated a low yield of positive CT findings for deep infection and limited impact of CT on surgical management. A high incidence of patients undergoing multiple radiologic examinations suggests uncertainty in selecting appropriate imaging modalities in this clinical scenario.</div></div><div><h3>Summary</h3><div>This single-center retrospective analysis found that CT examination of patients with clinically diagnosed cellulitis of the extremities has significantly low yield for deep infection in the lower extremities.</div></div>\",\"PeriodicalId\":49044,\"journal\":{\"name\":\"Journal of the American College of Radiology\",\"volume\":\"22 1\",\"pages\":\"Pages 76-83\"},\"PeriodicalIF\":4.0000,\"publicationDate\":\"2025-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of the American College of Radiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1546144024008524\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the American College of Radiology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1546144024008524","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}
Utilization of CT for Extremity Cellulitis: A Retrospective Single-Center Analysis
Purpose
Routine imaging of soft tissue infection is not recommended and represents a potential area of CT overuse. The utility of CT in patients with superficial soft tissue infection of the extremities is unknown. The purpose of this study is to evaluate the utilization and clinical impact of CT ordered in the setting of extremity cellulitis.
Methods
We retrospectively analyzed patients with extremity cellulitis examined with CT between 2012 and 2021 at a single center. We collected patient history, diagnostic imaging characteristics, and subsequent surgery decision. We hypothesized that yield of CT for deep infection was significantly lower than 10% and that yield was decreasing over time. These hypotheses were evaluated with Rao-Scott χ2 tests and repeated measures logistic regression.
Results
There were 496 eligible encounters among 463 patients. Yield of positive CT among lower extremity patients was 5.5% (95% confidence interval 3.33-7.75), significantly less than our hypothesis of 10% (P = .003). In 71.8% of encounters, patients underwent diagnostic imaging studies in addition to CT. Utilization rose from 0.08% per hospital visit in 2012 to 2013 to 0.14% in 2020 to 2021, with differences in yield between time periods not reaching statistical significance (P = .059). Among 496 encounters, 62 received surgery (12.1%), with 21 of these cases preceded by a positive CT for deep infection.
Conclusions
Our 10-year single-center analysis of CT use for extremity cellulitis demonstrated a low yield of positive CT findings for deep infection and limited impact of CT on surgical management. A high incidence of patients undergoing multiple radiologic examinations suggests uncertainty in selecting appropriate imaging modalities in this clinical scenario.
Summary
This single-center retrospective analysis found that CT examination of patients with clinically diagnosed cellulitis of the extremities has significantly low yield for deep infection in the lower extremities.
期刊介绍：
The official journal of the American College of Radiology, JACR informs its readers of timely, pertinent, and important topics affecting the practice of diagnostic radiologists, interventional radiologists, medical physicists, and radiation oncologists. In so doing, JACR improves their practices and helps optimize their role in the health care system. By providing a forum for informative, well-written articles on health policy, clinical practice, practice management, data science, and education, JACR engages readers in a dialogue that ultimately benefits patient care.
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