Dermatology Consultation for Cellulitis

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Massachusetts General Hospital

Must not be taking: Antithymocyte globulin, Campath, Prednisone

Disqualifiers: Postoperative infection, Osteomyelitis, Transplantation, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 1

Duration: Hospital stay duration

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores whether a dermatologist's evaluation of patients with cellulitis (a bacterial skin infection) soon after hospital admission can shorten hospital stays and reduce readmissions. The study compares two groups: one receiving early dermatology consultation and the other receiving standard care from an internal medicine doctor. Researchers aim to determine if early dermatologist involvement reduces antibiotic use and accurately identifies pseudocellulitis (a condition that mimics cellulitis). Individuals diagnosed with cellulitis who can follow the study procedures may be suitable candidates for this trial. As an unphased trial, this study offers a unique opportunity to contribute to research that could enhance hospital care for cellulitis patients.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What prior data suggests that dermatology consultation for cellulitis is safe?

Research shows that early consultation with a dermatologist can improve outcomes for people with suspected cellulitis. Studies have found that these consultations facilitate accurate diagnosis and help avoid unnecessary antibiotics. Additionally, early dermatologist visits can identify those who do not have cellulitis, potentially shortening their hospital stay. Reports of negative effects from seeing a dermatologist are rare. Overall, early involvement of a dermatologist is well-received and can enhance care. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores the impact of early dermatology consultation on cellulitis management. Unlike the standard approach, which relies on general internal medicine recommendations, this trial emphasizes a prompt dermatological evaluation within 24 hours of admission. This proactive strategy could potentially reduce readmission rates by ensuring targeted skin and lymph node assessments. By integrating dermatology expertise early in the treatment process, it aims to improve patient outcomes and offer more personalized care for cellulitis.

What evidence suggests that early dermatology consultation is effective for reducing hospital length of stay and readmission rates in cellulitis patients?

Research has shown that early consultation with a dermatologist for suspected cellulitis can greatly improve patient outcomes. In this trial, participants in the treatment arm will receive a dermatology consultation within 24 hours of admission. Studies have found that early dermatologist involvement can reduce unnecessary antibiotic use by 74.4%. It also improves diagnostic accuracy, leading to fewer mistakes in identifying cellulitis. Dermatologists identify different conditions in 28% to 83% of cases, which helps in selecting the right treatment more quickly. Additionally, early dermatologist consultations may shorten hospital stays, potentially reducing inpatient days nationally by up to 256,000 days. This approach ensures patients receive the right care more quickly, which can lower costs and improve recovery times. ^{1 2 5 6 7}

Who Is on the Research Team?

Daniela Kroshinsky, MD

Principal Investigator

Massachusetts General Hospital

Are You a Good Fit for This Trial?

This trial is for adults who can consent and follow study procedures, with a presumed diagnosis of cellulitis by the medical team. It excludes those under 18, pregnant women, prisoners, patients with certain infections or recent transplants, on high-dose steroids, or with abnormal vital signs.

Inclusion Criteria

Able to understand and sign informed consent

Able to complete study and comply with study procedures

My doctor thinks I have cellulitis.

Exclusion Criteria

You have an infection around any medical devices or tubes in your body.

I had a transplant less than 6 months ago or faced rejection in the last 3 months.

I have been diagnosed with osteomyelitis.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1 week

Treatment

Patients are admitted to the hospital for cellulitis and receive either standard care or additional dermatology consultation within 24 hours

Hospital stay duration

Follow-up

Participants are monitored for readmission rates and antibiotic usage after discharge

4 weeks

1 follow-up visit in dermatology clinic for treatment group, 1 follow-up phone call for control group

What Are the Treatments Tested in This Trial?

Interventions

• Dermatology Consultation

Trial Overview The study compares standard care by internal medicine hospitalists to care that includes an early dermatology consult within 24 hours of admission for cellulitis. The goal is to see if this reduces hospital stay length, readmission rates, costs and antibiotic use.

How Is the Trial Designed?

Group I: Dermatology Consult Active Control 1 Intervention

The patients randomized to the treatment group will obtain a dermatology evaluation within 24 hours of being admitted to MGH for their cellulitis. The skin and lymph node exam performed by the dermatologist on patients in the treatment group will be documented in the LMR for the subjects' medical records. Patients who are readmitted for cellulitis within one month of being discharged from the hospital will be considered treatment failures. Patients in the treatment group will have a follow-up visit in dermatology clinic within two weeks after being discharged. There will also be a medical record review performed one month after the patient's initial discharge from the hospital to assess for readmission.

Group II: No consult Active Control 1 Intervention

Those who are in the control group will follow internal medicine hospitalist recommendations alone which will include when and what type of post-discharge follow-up appointments the patient will have. We would like to emphasize that as part of the standard of care, patients in the control arm may still receive a dermatology consult if it is deemed necessary and/or requested. We will not prevent patients or the patient's team of caregivers from requesting a dermatology consultation during the course of hospitalization. A follow-up phone call will be performed two weeks after discharge for patients in the control group in order to confirm the patient's outcome. There will also be a medical record review one month after the patient's initial discharge from the hospital to assess for readmission

Who Is Running the Clinical Trial?

Massachusetts General Hospital

Lead Sponsor

Trials

3,066

Recruited

13,430,000+

Dermatology Foundation

Collaborator

Trials

5

Recruited

360+

Published Research Related to This Trial

A retrospective study of New Zealand dermatologists revealed that while dermatological surgeries in outpatient settings are generally safe, with low rates of infection (<3.5%) and bleeding (<2%), there is a need for improved preoperative and intraoperative monitoring practices.

Most dermatologists do not routinely record vital signs during procedures and often do not withhold anticoagulation or antiplatelet therapies, indicating a potential gap in safety protocols that could be addressed to enhance patient care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Perioperative management and the associated rate of adverse events in dermatological procedures performed by dermatologists in New Zealand. Chan, BC., Patel, DC.[2015]

Current strategies for monitoring adverse events (AEs) in dermatologic surgery are inconsistent, with morbidity and mortality conferences being the most common reporting method, but more sensitive approaches like retrospective medical record reviews and anonymous electronic systems exist.

There is no standard for AE reporting in dermatologic surgery, highlighting the need for pilot studies to establish effective measures that can enhance AE detection and improve patient safety outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Detecting adverse events in dermatologic surgery. Pinney, D., Pearce, DJ., Feldman, SR.[2019]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC5876891/

Effect of Dermatology Consultation on Outcomes for ... This study was designed to determine whether early dermatology consultation can improve treatment of hospitalized patients with suspected ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC5876861/

Outcomes of Early Dermatology Consultation for Inpatients ... This cohort study found that early dermatology consultation for presumed cellulitis decreased rates of unnecessary antibiotic use by 74.4% and unnecessary ...

3. jamanetwork.com jamanetwork.com/journals/jamadermatology/fullarticle/1897307

The Impact of Dermatology Consultation on Diagnostic ... Dermatology consultation in the primary care setting improves the diagnostic accuracy of suspected cellulitis and decreases unnecessary antibiotic use.

4. sciencedirect.com sciencedirect.com/science/article/pii/S0732889317300032

Clinical Studies Infectious diseases specialist management ... Several studies have suggested that dermatology consultation for cellulitis frequently leads to an alternative diagnosis with this occurring in 28–83% of cases ...

5. dermatologytimes.com dermatologytimes.com/view/inpatient-derm-consults-cellulitis-improve-outcomes

Inpatient derm consults for cellulitis improve outcomes When extrapolating the data nationally, researchers found that dermatology consultation could lead to a reduction of 97,000 to 256,000 inpatient days ...

6. clinicaltrials.gov clinicaltrials.gov/study/NCT01706913

Study Assessing Impact of Dermatology Consultation for ... Effect of Dermatology Consultation on Outcomes for Patients With Presumed Cellulitis: A Randomized Clinical Trial. JAMA Dermatol. 2018 May 1;154(5):529-536 ...

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9798350/

The utility of augmented teledermatology to improve ... Accuracy for cellulitis cases specifically significantly increased from 76 ± 6% to 88 ± 4% when adding a cellulitis questionnaire and thermal images (p = 0.049) ...