title: Prevalence of concurrent deep vein thrombosis in patients with lower limb cellulitis: a prospective cohort study.
abstract: BACKGROUND
  Lower limb cellulitis and deep vein thrombosis share clinical features and investigation of patients with cellulitis for concurrent DVT is common. The prevalence of DVT in this group is uncertain. This study aimed to determine the prevalence of deep vein thrombosis (DVT) in patients with lower limb cellulitis and to investigate the utility of applying the Wells algorithm to this patient group.
  
  
  METHODS
  Patients admitted with lower limb cellulitis prospectively underwent a likelihood assessment for DVT using the Wells criteria followed by investigation with D-dimer and ultrasonography of ipsilateral femoral veins as appropriate. Diagnoses of contralateral DVT or pulmonary embolism during admission were recorded.
  
  
  RESULTS
  200 patients assessed for DVT. 20% of subjects were high risk by Wells criteria. D-dimer was elevated in 74% and 79% underwent insonation of the affected leg. Ipsilateral DVT was found in 1 patient (0.5%) and non-ipsilateral VTE in a further 2 (1%).
  
  
  CONCLUSIONS
  Deep vein thrombosis rarely occurs concurrently with lower limb cellulitis. The Wells score substantially overestimates the likelihood of DVT due to an overlap of clinical signs. Investigation for DVT in patients with cellulitis is likely to yield few diagnoses and is not warranted in the absence of a hypercoaguable state.
  
  
  BACKGROUND
  ACTRN: 12610000792022 (https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=320662).
authors.affiliation: Department of Infectious Diseases, Christchurch Hospital, Christchurch, 8002, New Zealand. Michael.Maze@cdhb.health.nz
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Maze
authors.forename: Sean
authors.initials: S
authors.lastname: Skea
authors.forename: Alan
authors.initials: A
authors.lastname: Pithie
authors.forename: Sarah
authors.initials: S
authors.lastname: Metcalf
authors.forename: John F
authors.initials: JF
authors.lastname: Pearson
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Chambers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002481:Cellulitis / Q000150:complications* / Q000453:epidemiology; D004886:Erysipelas / Q000150:complications / Q000453:epidemiology; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006801:Humans; D007866:Leg / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D