NURS FPX 4025 Assessment 1
NURS FPX 4025 Assessment 1
Name
Capella university
NURS-FPX4025 Research and Evidence-Based Decision Making
Prof. Name
Date
Abstract
Abstract of Article
Validation of Thermal Imaging and the ALT-70 Prediction Model to Differentiate Cellulitis From Pseudocellulitis
Authors:Michael S. Pulia, MD¹; Rebecca J. Schwei, MS¹; Roxana Alexandridis, PhD¹; Michael R. Lazarov, BS¹; Edward Harkins, BS¹; Robert Gilbert, MS¹; Ambar Haleem¹; Jamie Hess¹; Thomas G. Keenan II, MD¹; Joseph A. Merola, MD²; Robert Rohekar, MD²
Affiliations: expand
PMID: 38351640
PMCID: PMC10974680
DOI: 10.1001/jamadermatol.2024.0091
Abstract
Importance:
Cellulitis is misdiagnosed in up to 30% of cases due to mimic conditions termed pseudocellulitis. The resulting overuse of antibiotics is a threat to patient safety and public health. Surface thermal imaging and the ALT-70 (asymmetry, leukocytosis, tachycardia, and age ≥70 years) prediction model have been proposed as tools to help differentiate cellulitis from pseudocellulitis.
Objectives:
To validate differences in skin surface temperatures between patients with cellulitis and patients with pseudocellulitis, assess the measurement of one point for differentiating cellulitis from pseudocellulitis, and compare the performance of skin surface temperature and the ALT-70 prediction model in differentiating cellulitis from pseudocellulitis.
Design, setting, and participants:
This prospective diagnostic validation study was conducted among patients who presented to the emergency department with acute dermal/subdermal lower extremity symptoms from October 11, 2018, through March 11, 2020. Statistical analysis was performed from July 2020 to March 2021 and work concluded in September 2023.
Main outcomes and measures:
Retrospective medical chart data and unreflected skin temperatures were obtained. Cellulitis vs pseudocellulitis was assessed by a 6-physician independent consensus review. Differences in temperature measurements were analyzed using t test. Logistic regression was used to identify the temperature measure and cut point with the best performance for discriminating between cellulitis and pseudocellulitis. Diagnostic performance characteristics for the ALT-70 prediction model, surface skin temperature, and both combined were also assessed.
Results:
The final sample included 200 patients (mean [SD] age, 56.6 [16.5] years; 120 participants [59.5%], 92 [45.1%] of whom had a consensus diagnosis of cellulitis). There were statistically significant differences in skin surface temperature measures (mean temperature, maximum affected limb, and gradients) between cellulitis and pseudocellulitis. The mean temperature of the affected limb for patients with cellulitis was 33.2 °C compared with 31.2 °C for those with pseudocellulitis (difference, 2.0 °C [95% CI, 1.3-2.7 °C]; P < .001). The minimum gradient temperature performance measure was +1.3 °C point of 91.2 °C in maximum (SD) temperature difference value of 91.5% (47%) and a sensitivity of all 3 measures remained high and exceeded 90%, while specificity varied considerably (ALT-70, 20.2% [95% CI, 15.8%-28.1%]; maximum temperature difference of the affected limb, 38.4%, [95% CI, 28.9%-49.5%]; gradient max, 95% CI, 46.5%-61.2%).
Conclusions and relevance:
In this large diagnostic validation study, significant differences in skin surface temperature measures were observed between cases of cellulitis and pseudocellulitis. Thermal imaging and the ALT-70 both had diagnostic potential with improved performance when combining the 2 measures. These findings highlight the potential of thermal imaging, alone or in combination with the ALT-70 prediction model, as a diagnostic adjunct that may reduce overdiagnosis of cellulitis.
Keywords
Lower limb cellulitis, pseudo cellulitis, thermal imaging, ALT-70 prediction model, skin surface temperature, diagnostic validation.
Reference
Pulia, M. S., Schwei, R. J., Alexandridis, R., Lasarev, M. R., Harwick, E., Glinert, R., Haleem, A., Hess, J., Keenan, T. D., McBride, J. A., & Redwood, R. (2024). Validation of thermal imaging and the ALT-70 prediction model to differentiate cellulitis from pseudocellulitis. JAMA Dermatology, 160(5), 511–517.
DOI
https://doi.org/10.1001/jamadermatol.2024.0091
Published Date
March 27, 2024
Figure 02
Sentinel U Patient Screenshot
NURS FPX 4025 Assessment 1
Table 01
Article Description
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Criterion |
Question |
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1 |
Summary of the Type of Study: This is a prospective diagnostic validation study. It aimed to assess and validate the differences in skin surface temperature between patients with cellulitis and those with pseudo-cellulitis. It compares the performance of skin surface temperature measures and the ALT-70 prediction model in differentiating the two conditions. Prospective diagnostic validation studies integrate findings from large, diverse patient populations, advanced diagnostic tools, and expert consensus to provide evidence-based conclusions that enhance clinical decision-making and improve diagnostic accuracy in real-world healthcare settings. This article presents strong evidence regarding the diagnostic accuracy of thermal imaging in evaluating cellulitis. It suggests that prospective diagnostic validation studies are essential for determining the most reliable clinical indicators for cellulitis and guiding appropriate antibiotic therapy. Potential limitations include the study’s single-center design and the predominantly White population, which limit the generalizability of the findings to more diverse populations. The use of convenience sampling and the focus on more severe cellulitis cases in the ED affect the applicability of the results to all patient cohorts. |
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2. |
Credibility of Article: Numerous key descriptions strengthen the credibility of this article. It is a prospective diagnostic validation study highlighting thermal imaging, combined with the ALT-70 prediction model. It improves diagnostic performance, particularly in differentiating cellulitis from pseudo-cellulitis. The article was published in the highly trustworthy Journal of the American Medical Association Dermatology. This comprehensive paper critically evaluates research and strategies for diagnosing cellulitis. The authors, experts in dermatology and infectious diseases, used high-quality studies. The article includes randomized controlled trials, observational studies, and clinical guidelines to support it and make it more valid. In addition, it presents evidence-based recommendations for improving diagnostic accuracy, such as integrating surface thermal imaging with the ALT-70 prediction model to enhance specificity and sensitivity. It uses maximum skin temperature as a primary diagnostic indicator, and optimizes diagnostic protocols that combine these tools. These approvals aim to reduce overdiagnosis, minimize unnecessary antibiotic use, and improve clinical decision-making. As a result, this article is a trustworthy source of information for clinicians aiming to improve the diagnosis and treatment of cellulitis. |
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3 |
Importance of Content: This study analyzes the diagnostic accuracy and clinical management of lower limb cellulitis. It focuses on integrating thermal imaging with the ALT-70 prediction model. The article highlights key clinical findings, such as the significant improvement in diagnostic performance when these two tools are combined, particularly in differentiating cellulitis from pseudo-cellulitis. It emphasizes the potential for thermal imaging to reduce overdiagnosis and unnecessary antibiotic use, leading to better patient outcomes. The review also discusses the challenges of diagnostic uncertainty in the emergency department (ED) setting and the need for improved clinical tools to address these issues. It underscores the importance of validation studies to refine diagnostic thresholds and optimize treatment strategies for cellulitis. The article calls for further research to validate the findings in more diverse patient populations and to develop standardized guidelines for incorporating thermal imaging and predictive models into routine clinical practice. |
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4 |
Ability to Apply Content to the Workplace: The findings from this diagnostic validation study are highly relevant to clinical practice in diagnosing and managing lower limb cellulitis, where accurate differentiation between cellulitis and pseudo-cellulitis is crucial. The article presents evidence-based guidance on when to incorporate thermal imaging and the ALT-70 prediction model into clinical decision-making to improve diagnostic accuracy and reduce unnecessary antibiotic use. Using these tools, clinicians can determine the severity of cellulitis and tailor treatment plans accordingly, potentially avoiding overtreatment. The study highlights the potential for using thermal imaging to identify cases that do not require intensive interventions, thus guiding more appropriate management strategies. The review suggests that combining thermal imaging with existing diagnostic models could optimize patient outcomes by enhancing diagnostic precision and minimizing the risks associated with antibiotic overuse, such as antibiotic resistance. |
Analyzing a Research Paper
As shown in Figure 01, evaluating diagnostic tools for cellulitis provides crucial insights into clinical assessment and diagnostic accuracy. While clinical evaluation and antibiotic therapy remain foundational in treating cellulitis, the study underscores that thermal imaging, combined with the ALT-70 prediction model, can improve diagnostic performance, particularly in differentiating cellulitis from pseudo-cellulitis.
Early and accurate clinical assessment is important, especially in identifying key diagnostic features, such as temperature elevations and affected skin areas. High-risk factors, such as diabetes and immunosuppression, are also highlighted, as they are associated with increased risk of complications. These findings are essential for informed clinical decision-making. It safeguards timely and appropriate treatment while minimizing complications. Healthcare providers can optimize patient outcomes and decrease unnecessary healthcare burdens.
The article is highly credible and was published in the esteemed Journal of the American Medical Association Dermatology. It is a reputable, peer-reviewed medical journal. It employs a rigorous prospective diagnostic validation study methodology, enhancing its reliability. The comprehensive analysis of thermal imaging and the ALT-70 prediction model for diagnosing lower limb cellulitis provides valuable insights into improving diagnostic accuracy and clinical decision-making. These findings are particularly relevant for emergency departments where swift and accurate diagnosis is critical. Further research is needed to validate these findings in diverse populations and explore the optimal integration of these tools into clinical practice. This study offers important, evidence-based guidance for the clinical management of cellulitis. It promotes more efficient, accurate, and personalized diagnostic strategies.
Reference
Pulia, M. S., Schwei, R. J., Alexandridis, R., Lasarev, M. R., Harwick, E., Glinert, R., Haleem, A., Hess, J., Keenan, T. D., McBride, J. A., & Redwood, R. (2024). Validation of thermal imaging and the ALT-70 prediction model to differentiate cellulitis from pseudocellulitis. Journal of the American Medical Association Dermatology, 160(5), 511–517. https://doi.org/10.1001/jamadermatol.2024.0091