title: Utility of Lower Extremity Doppler in Patients with Lower Extremity Cellulitis: A Need to Change the Practice?
abstract: OBJECTIVE
  Cellulitis and deep vein thrombosis (DVT) in the lower extremities (LE) often have similar presentations: erythema, swelling, and calf tenderness. The overlap of these symptoms often results in physicians ordering unnecessary LE Doppler ultrasounds in patients with LE cellulitis. This practice leads to subjecting patients to unwarranted procedures and results in increased healthcare costs. We aimed to determine the percentage of Doppler ultrasounds performed in patients admitted with LE cellulitis and the prevalence of DVT in that population.
  
  
  METHODS
  A retrospective chart review was performed of the patients admitted January 1, 2009 to June 30, 2013 who had a diagnosis of LE cellulitis. The number of Doppler ultrasounds performed and the presence of DVT was recorded. Patients were divided into groups of Doppler ultrasounds with no DVT and Doppler ultrasounds that were positive for DVT to compare the risk factors.
  
  
  RESULTS
  There were 624 patients identified using the International Classification of Diseases, 9th Revision code for LE cellulitis at the time of admission. Slightly more than half of the subjects were men (315/624) and the average age was 61.4 ± 18.8 years (mean ± standard deviation). There were 417 (66.8%) patients who underwent Doppler ultrasound. Only 25 (5.9%) patients had DVT. Multivariate analysis showed that prior cerebrovascular accident, calf swelling, and history of thromboembolism were statistically significant predictors for DVT (P < 0.05).
  
  
  CONCLUSIONS
  A concurrent incidence of DVT and LE cellulitis is rare. In the absence of known risk factors of DVT, the yield of LE Doppler is low and Doppler ultrasound is not required as a part of a standard admission evaluation.
authors.affiliation: From the Grand Rapids Medical Education Partners/Michigan State University Internal Medicine Residency, and Spectrum Health, Grand Rapids, Michigan.
authors.forename: Muhammad Zubair
authors.initials: MZ
authors.lastname: Afzal
authors.affiliation: From the Grand Rapids Medical Education Partners/Michigan State University Internal Medicine Residency, and Spectrum Health, Grand Rapids, Michigan.
authors.forename: Mian Muhammad
authors.initials: MM
authors.lastname: Saleh
authors.affiliation: From the Grand Rapids Medical Education Partners/Michigan State University Internal Medicine Residency, and Spectrum Health, Grand Rapids, Michigan.
authors.forename: Syed
authors.initials: S
authors.lastname: Razvi
authors.affiliation: From the Grand Rapids Medical Education Partners/Michigan State University Internal Medicine Residency, and Spectrum Health, Grand Rapids, Michigan.
authors.forename: Hamza
authors.initials: H
authors.lastname: Hashmi
authors.affiliation: From the Grand Rapids Medical Education Partners/Michigan State University Internal Medicine Residency, and Spectrum Health, Grand Rapids, Michigan.
authors.forename: Russell
authors.initials: R
authors.lastname: Lampen
mesh_terms: D000328:Adult; D000368:Aged; D002481:Cellulitis / Q000175:diagnosis / Q000453:epidemiology; D003937:Diagnosis, Differential; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D063189:Symptom Assessment / Q000379:methods*; D018616:Ultrasonography, Doppler, Duplex / Q000379:methods / Q000706:statistics & numerical data; D019564:Unnecessary Procedures / Q000706:statistics & numerical data; D020246:Venous Thrombosis / Q000175:diagnosis / Q000453:epidemiology