Factors related to deep vein thrombosis in patients with cellulitis/erysipelas at two high-complexity facilities

A case-control study

Abstract

Lower extremity venous thromboembolism in the presence of soft tissue infection (cellulitis/ erysipelas) is difficult to diagnose using clinical findings alone. This leads to an overuse of Doppler ultrasound, which is unnecessary in many cases. In Colombia, there are no studies to date reporting the simultaneous prevalence of these two conditions

Objective: to determine which factors are related to deep vein thrombosis in patients with lower extremity cellulitis/erysipelas.

Materials and methods: a case-control study. Patients seen at Hospital Pablo Tobón Uribe and the university hospital between January 2018 and December 2019 who were diagnosed with cellulitis/ erysipelas and underwent lower extremity venous Doppler. Demographic, clinical, laboratory and imaging variables were considered.

Results: altogether, 637 patients with a diagnosis of lower extremity cellulitis and erysipelas were found during the study period in both institutions. Of these, 18.5% (118 patients) had a lower extremity Doppler ultrasound ordered to rule out deep vein thrombosis, finding a total of 25 positive studies (21.19%). Out of the total sample, 56 (47.4%) were male, with a mean age of 65 years. Most of the cases (55.08%) had an intermediate risk according to the Wells scale. The most common patient factors related to thrombosis were: immobility 33%, lymphedema 29.66%, and chronic kidney disease 23.73%. Neoplasms were the factor which showed statistical significance for the presence of thrombosis OR 5 (1.64-15.16) (P=0.0056).

Conclusions: cellulitis is not a unique finding to justify carrying out a Doppler test, and the routine use of this imaging technique in the diagnostic approach is not justified if there are no other risk factors for thrombosis.