title: Cellulitis Recurrence Score: a tool for predicting recurrence of lower limb cellulitis.
abstract: BACKGROUND
  Cellulitis is the most common skin and soft tissue infection and is associated with frequent recurrences.
  
  
  OBJECTIVE
  An objective of our study was to identify factors for recurrence in patients who present with a first episode of lower-limb cellulitis. A secondary aim was to formulate a score based on observed clinical risk factors that might predict recurrence within a year.
  
  
  METHODS
  Dermatology referral forms and national computerized records were reviewed from 2003 to 2012. Demographics, coexistent dermatoses, local factors, and comorbidities were reviewed.
  
  
  RESULTS
  A total of 102 (45.3%) of 225 patients had recurrence. Multivariate analysis showed that lymphedema (P < .0005), chronic venous insufficiency (P < .0005), peripheral vascular disease (P = .002), and deep vein thrombosis (P = .008) predicted for recurrence. The Cellulitis Recurrence Score (CRS) was constructed based on these factors. CRS ≥ 2 was associated with a positive predictive value of 83.6% and negative predictive value of 67.5%. Model performance was good (Hosmer-Lemeshow statistic, P = .753).
  
  
  CONCLUSIONS
  This is a retrospective study limited to an inpatient cohort.
  
  
  CONCLUSIONS
  Lymphedema, chronic venous insufficiency, peripheral vascular disease, and deep vein thrombosis were risk factors. CRS is reliable for predicting recurrence, and early interventions should be considered in patients with CRS ≥ 2.
authors.affiliation: National Skin Centre, Singapore.
authors.forename: Evelyn Yuxin
authors.initials: EY
authors.lastname: Tay
authors.affiliation: Health Services Research and Biostatistics, Division of Research, Singapore General Hospital, Singapore.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Fook-Chong
authors.affiliation: Dermatology Unit, Singapore General Hospital, Singapore.
authors.forename: Choon Chiat
authors.initials: CC
authors.lastname: Oh
authors.affiliation: Dermatology Unit, Singapore General Hospital, Singapore.
authors.forename: Thamotharampillai
authors.initials: T
authors.lastname: Thirumoorthy
authors.affiliation: Dermatology Unit, Singapore General Hospital, Singapore.
authors.forename: Shiu Ming
authors.initials: SM
authors.lastname: Pang
authors.affiliation: Dermatology Unit, Singapore General Hospital, Singapore. Electronic address: lee.haur.yueh@sgh.com.sg.
authors.forename: Haur Yueh
authors.initials: HY
authors.lastname: Lee
mesh_terms: D002481:Cellulitis / Q000453:epidemiology* / Q000209:etiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007868:Leg Dermatoses / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors
keywords: cellulitis; chronic venous insufficiency; deep vein thrombosis; erysipelas; lymphedema; peripheral vascular disease; recurrence; stasis dermatitis