Sonographic Features of Cellulitis and Failure of Therapy



Status:Completed
Conditions:Cosmetic
Therapuetic Areas:Dermatology / Plastic Surgery
Healthy:No
Age Range:18 - Any
Updated:7/16/2013
Start Date:January 2013
End Date:October 2014
Contact:Romolo Gaspari, MD, PhD
Email:romolo.gaspari@umassmemorial.org
Phone:508-334-7943

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Skin and soft tissue infections represent a tremendous burden to the health care community
with over 11.6 million ambulatory patients presenting annually in 2003 and 14.2 million in
2005. A Cochrane review of cellulitis found that there is limited data to support any
specific antibiotic or even a specific length of antibiotic therapy, and that outpatient
therapy for cellulitis is increasing. Soft tissue ultrasound has been shown to have utility
in differentiating cellulitis from abscess but its role in patients with cellulitis is not
well developed. Although speculative, the investigators hypothesize that sonographic
features of cellulitis are associated with clinical improvement and successful therapy
following antibiotics for patients with cellulitis.


The primary objective is to determine if changes in the sonographic features of cellulitis
are associated with failure of therapy. Patients with cellulitis treated in the ED with
either intravenous or oral antibiotics will undergo imaging using a standardized ultrasound
protocol. Patients will be screened and enrolled in the ED at the UMASS Memorial Medical
Center. The study design is single center prospective observational trial involving adult
patients with clinical signs of cellulitis requiring antibiotics but not admitted to the
hospital. Patients will be imaged upon initial presentation to the ED. Patients discharged
from the ED after the initial visit will return to the ED in 24 to 48 hours for a
reassessment. Patients kept in the ED under observational status will undergo an identical
reassessment. Clinical staff blinded to the ultrasound results will characterize patients as
improving, no change or worsening based on progression of the erythema despite antibiotics
or change in clinical status. Researchers blinded to the clinical data will review the
ultrasound images to quantify the extent of the sonographic evidence of cellulitis compared
to the extent of the erythema by physical exam findings.

Inclusion Criteria:

- 18 years or older Symptoms of cellulitis (localized warmth, erythema, swelling or
tenderness)

Exclusion Criteria:

Admitted for inpatient antibiotics Unable to consent Septic appearing crepitus on exam
animal bite soft tissue abscess osteomylitis cellulitis requiring surgical debridement
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