Conference Coverage

ALT-70 score outperformed thermal imaging for cellulitis diagnosis

 

Key clinical point: The ALT-70 score surpassed thermal imaging for diagnosing lower-extremity cellulitis.

Major finding: Positive and negative predictive values were 80.4% and 90.9% for ALT-70 and 75.5% and 57.1% for thermal imaging.

Study details: A single-center study with 67 patients.

Disclosures: Mr. Li had no disclosures.

Source: Li DG et al. AAD 18, Abstract 6744.


 

REPORTING FROM AAD 18


The four-item survey can generate a score of 0-7, with a score of 0-2 suggesting need for additional monitoring, a score of 3-4 initiating a dermatology consult, and a score of 5-7 triggering immediate treatment for cellulitis, Mr. Li said. The 2017 review of ALT-70 showed that among 259 patients, those with a score of 0-2 had an 83% likelihood of having pseudocellulitis, while patients with a score of 5-7 had an 82% likelihood of having true cellulitis.

Arash Mostaghimi, MD, Director, Inpatient Consultation Service, Department of Dermatology, Brigham and Women's Hospital, Boston Brigham and Women's Hospital

Dr. Arash Mostaghimi

Thermal imaging of the lower extremity, which identifies cellulitis by a higher skin temperature compared with unaffected areas on the limb, has also recently gained currency as a way to objectively diagnose cellulitis (J Invest Dermatol. 2018 March;138[3]:520-6).

The current study enrolled 67 patients who had a presumptive diagnosis of LEC while in the emergency department or inpatient wards during a 7-month period. In addition to undergoing blinded assessment by both thermal imaging and by ALT-70 scoring, all patients also underwent blinded assessment by a board-certified dermatologist, who provided the definitive diagnosis. The attending dermatologists determined that 46 of the patients had true LEC and 21 patients did not.

The calculated sensitivity of ALT-70 was 97.8%, compared with 87.0% for thermal imaging. Specificity was 47.6% for ALT-70 and 38.1% for thermal imaging, Mr. Li reported at the annual meeting of the American Academy of Dermatology.

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