Prevalence of concurrent deep vein thrombosis in patients with lower limb cellulitis: a prospective cohort study

Michael J Maze,John F Pearson,Sarah Metcalf,Alan Pithie,Stephen T Chambers,Sean Skea

doi:10.1186/1471-2334-13-141

Michael J Maze, John F Pearson + Show 4 more

Open Access

https://doi.org/10.1186/1471-2334-13-141

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Abstract

BackgroundLower 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.MethodsPatients 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.Results200 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%).ConclusionsDeep 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.Trial registrationACTRN: 12610000792022 (https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=320662)

Highlights

Lower limb cellulitis and deep vein thrombosis share clinical features and investigation of patients with cellulitis for concurrent DVT is common
Cellulitis of the lower limb shares several clinical characteristics with deep vein thrombosis (DVT) and both have variability of clinical signs. These factors may lead to diagnostic uncertainty. This is important in patients with clinically diagnosed cellulitis who are slow to respond to antimicrobials
In patients with skin and soft tissue infection there is a significant overlap of clinical signs with those of DVT, and the Wells score may be invalid if the prevalence of DVT is much lower in this population

Summary

Introduction

Lower limb cellulitis and deep vein thrombosis share clinical features and investigation of patients with cellulitis for concurrent DVT is common. 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. Cellulitis of the lower limb shares several clinical characteristics with deep vein thrombosis (DVT) and both have variability of clinical signs. These factors may lead to diagnostic uncertainty. In patients with skin and soft tissue infection there is a significant overlap of clinical signs with those of DVT, and the Wells score may be invalid if the prevalence of DVT is much lower in this population

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