A systematic review showing the lack of diagnostic criteria and tools developed for lower limb cellulitis

Background Cellulitis can be a difficult diagnosis to make. 31% of patients admitted from the emergency department with suspected lower limb cellulitis are misdiagnoses, with incorrect treatment potentially resulting in avoidable hospital admission and antibiotic prescribing. Objective We sought to identify diagnostic criteria or tools that have been developed for lower limb cellulitis. Methods We conducted a systematic review using Ovid MEDLINE and Embase databases in May 2018, with the aim of describing diagnostic criteria and tools developed for lower limb cellulitis, and assessing the quality of the studies identified, using the QUADAS‐2 tool. We included all types of study describing diagnostic criteria or tools. Results Eight observational studies were included. Five studies examined biochemical markers, two studies assessed imaging and one study developed a diagnostic decision model. All eight studies were high risk in at least one domain for bias. Limitations The quantity and quality of available data was low. Results could not be pooled due to the heterogeneity in findings. Conclusion There is a lack of high quality publications describing criteria or tools for diagnosing lower limb cellulitis. Future studies using prospective designs and validated in both primary and secondary care settings are needed.