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Volume 3, Issue 2, April 2015, Page: 8-11
Developing a Scoring System to Determine Necessity and Timing of Surgical Intervention in the Treatment of Cellulitis
Narayana Subramaniam, Department of General Surgery, M.S. Ramaiah Medical College and Hospital, Bangalore, India
Bharati V. Hiremath, Department of General Surgery, M.S. Ramaiah Medical College and Hospital, Bangalore, India
Balakrishna M. Naik, Department of General Surgery, M.S. Ramaiah Medical College and Hospital, Bangalore, India
Received: Feb. 18, 2015;       Accepted: Mar. 7, 2015;       Published: Mar. 13, 2015
DOI: 10.11648/j.js.20150302.11      View  3014      Downloads  171
Abstract
Aim: To develop a clinico-pathological scoring system to determine necessity and timing of surgical intervention in cellulitis. Introduction: Cellulitis is a major cause of morbidity, however standard plan of care and treatment guidelines are far from standardized. Our study was done to determine the clinical and pathological markers indicating the need for surgical intervention and derivation of a scoring system. Materials and methods: Cross-sectional prospective observational study of 148 patients of cellulitis presenting to M.S. Ramaiah Hospitals between Jan. 2012 and 2014. Based on clinical judgement they were divided into two groups – those who required surgical intervention and those who did not. All cases were evaluated in terms of clinical and pathological characteristics. These parameters were compared in the two groups and the clinical and laboratory findings that were altered to a degree of statistical significance in those undergoing surgical intervention were noted; the relative risk ratio for surgical intervention of each was taken as a component of the final scoring system. Results: The physical and biochemical parameters found to have a statistically significant correlation with surgical intervention – percentage of area involved (p<0.001), skin necrosis (p<0.001), stretch pain (p<0.001), chronic kidney disease (p<0.002), diabetes mellitus (p<0.002), hyponatremia (p<0.006) and degree of elevation in total count (p<0.001). These were used to derive the scoring system. Low risk was <5 points and high risk >10 points. Conclusion: This scoring system may be helpful to determine necessity and timing of surgical intervention in cellulitis, especially when to end trial of conservative management. Additionally it may provide risk stratification for prognostic value.
Keywords
Cellulitis, Surgery, Scoring System
To cite this article
Narayana Subramaniam, Bharati V. Hiremath, Balakrishna M. Naik, Developing a Scoring System to Determine Necessity and Timing of Surgical Intervention in the Treatment of Cellulitis, Journal of Surgery. Vol. 3, No. 2, 2015, pp. 8-11. doi: 10.11648/j.js.20150302.11
Reference
[1]
Stevens DL, Bisno AL, Chambers HF, Everett ED, Dellinger P, Goldstein EJ, et al. Practice guidelines for the diagnosis and management of skin and soft-tissue infections. Clin Infect Dis. 2005 Nov 15;41:1373-406.
[2]
DeFrances CJ, Lucas CA, Buie VC, Golosinskiy A. 2006 National Hospital Discharge Survey. National health statistics reports; no 5. Hyattsville, MD: National Center for Health Statistics; 2008
[3]
Cox NH, Colver GB, Paterson WD. Management and morbidity of cellulitis of the leg. J R Soc Med. 1998 Dec;91:634-7.
[4]
Morpeth SC, Chambers ST, Gallagher K, Frampton C, Pithie AD. Lower limb cellulitis: Features associated with length of hospital stay. J Infect. 2006 Jan;52:23-9
[5]
Dong SL, Kelly KD, Oland RC, Holroyd BR, Rowe BH. ED management of cellulitis: A review of five urban centers. Am J Emerg Med. 2001 Nov;19:535-40.
[6]
Börnsdóttir S, Gottfredsson M, Thórisdóttir AS, Gunnarsson GB, Ríkardsdóttir H, Kristjánsson M, et al. Risk factors for acute cellulitis of the lower limb: a prospective case-control study. Clin Infect Dis. Nov 15 2005;41:1416-22
[7]
Gabillot-Carré M, Roujeau JC. Acute bacterial skin infections and cellulitis. Curr Opin Infect Dis. Apr 2007;20:118-23
[8]
Vinh DC, Embil JM. Rapidly progressive soft tissue infections. Lancet Infect Dis. 2005 Aug;5:501-13
[9]
Carratala J, Roson B, Fernandez-Sabe N, Shaw E, del Rio O, Rivera A, et al. Factors associated with complications and mortality in adult patients hospitalized for infectious cellulitis. Eur J Clin Microbiol Infect Dis. 2003 Mar;22:151-7
[10]
Ellis Simonsen SM, van Orman ER, Hatch BE, et al. Cellulitis incidence in a defined population. Epidemiol Infect. Apr 2006;134:293-9
[11]
Wong CH, Khin LW, Heng KS, Tan KC, Low CO. The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med 2004;32:1535-41.
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