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Red Leg Dilemma: Development and Validation of Clinical Decision Tools for Non-Necrotizing Bacterial Dermohypodermitis, Necrotizing Fasciitis, and Eczematous Dermatitis.

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Τίτλος: Red Leg Dilemma: Development and Validation of Clinical Decision Tools for Non-Necrotizing Bacterial Dermohypodermitis, Necrotizing Fasciitis, and Eczematous Dermatitis.
Συγγραφείς: Skayem C; Assistance Publique des Hôpitaux de Paris (AP-HP), Department of Dermatology, Hôpital Henri Mondor, Creteil, France., Charras T; Université de Paris, Faculté de médecine, Paris, France., Tran VT; Université de Paris, Faculté de médecine, Paris, France.; Université de Paris, CRESS, INSERM, INRA, F-75004 Paris, France., Hua C; Assistance Publique des Hôpitaux de Paris (AP-HP), Department of Dermatology, Hôpital Henri Mondor, Creteil, France., Pham GD; Centre Hospitalier Intercommunal de Créteil, Créteil, France., Hirsch G; Assistance Publique des Hôpitaux de Paris (AP-HP), Department of Dermatology, Hôpital Henri Mondor, Creteil, France., Zehou O; Assistance Publique des Hôpitaux de Paris (AP-HP), Department of Dermatology, Hôpital Henri Mondor, Creteil, France., Duong TA; Chaire Avenir Santé numérique, Equipe 8 IMRB U 955, INSERM, Université Paris Est Créteil, Créteil, France.; Assistance Publique des Hôpitaux de Paris (AP-HP), Department of Telemedicine, Hôpital Université Paris-Saclay, Boulogne-Billancourt, France.
Πηγή: The international journal of lower extremity wounds [Int J Low Extrem Wounds] 2026 Sep; Vol. 25 (3), pp. 1052-1058. Date of Electronic Publication: 2024 Nov 18.
Τύπος έκδοσης: Journal Article; Validation Study
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Sage Publications Country of Publication: United States NLM ID: 101128359 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1552-6941 (Electronic) Linking ISSN: 15347346 NLM ISO Abbreviation: Int J Low Extrem Wounds Subsets: MEDLINE
Imprint Name(s): Original Publication: Thousand Oaks, CA : Sage Publications, c2002-
Ιατρικοί όροι (MeSH): Fasciitis, Necrotizing*/diagnosis , Fasciitis, Necrotizing*/microbiology , Fasciitis, Necrotizing*/drug therapy , Dermatitis*/diagnosis , Dermatitis*/microbiology , Cellulitis*/diagnosis , Cellulitis*/microbiology, Anti-Bacterial Agents/therapeutic use ; Humans ; Female ; Male ; Middle Aged ; Diagnosis, Differential ; Aged ; Sensitivity and Specificity
Περίληψη: BackgroundDiagnosing red legs on first presentation is challenging. There exists a lack of robustly developed and validated diagnostic red leg tools in clinical practice. Physicians fear missing cases of infectious red legs and treat many patients unnecessarily with antibiotics.ObjectiveDevelop and validate easy-to-use diagnostic tools applicable at bedside of patients to orient diagnosis of the commonest and most serious causes of infectious red legs (non-necrotizing bacterial dermohypodermitis (NNBDH), and necrotizing fasciitis (NF)) versus the commonest inflammatory cause (eczema).MethodsWe collected data of patients presenting to our dermatology department from January first 2012 until May 17th 2017 with a diagnosis of red leg. Three models were developed using fast frugal trees. Validation was performed in a second cohort of patients.ResultsA total of 187 patients (mean age 56, SD = 21 years, 48.1% women) were included in the development phase and 62 patients (mean age 64, SD = 19, 52% women) in the validation phase. In the validation data set, sensitivity and specificity were respectively 67% and 91% for NNBDH, 83% and 66%, for NF and 88% and 93%, for eczema.ConclusionPresentations of suspected lower-limb infections are commonly misdiagnosed, resulting in avoidable antibiotic prescription and hospitalization. We developed an easy-to-use clinical diagnostic tool applicable at the bedside of patients to help orient physicians in certain situations and avoid unnecessary initiation of antibiotics. Future work should focus on validating this tool in primary care to minimize misdiagnosis of red legs and overprescription of antibiotics.
Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Contributed Indexing: Keywords: lower extremity wound; pain < wound assessment; photography < wound; stasis ulcers < lower extremity wound; wound assessment
Substance Nomenclature: 0 (Anti-Bacterial Agents)
Entry Date(s): Date Created: 20241119 Date Completed: 20260805 Latest Revision: 20260805
Update Code: 20260806
DOI: 10.1177/15347346241290408
PMID: 39558656
Βάση Δεδομένων: MEDLINE
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  Data: Red Leg Dilemma: Development and Validation of Clinical Decision Tools for Non-Necrotizing Bacterial Dermohypodermitis, Necrotizing Fasciitis, and Eczematous Dermatitis.
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– Name: Abstract
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  Data: BackgroundDiagnosing red legs on first presentation is challenging. There exists a lack of robustly developed and validated diagnostic red leg tools in clinical practice. Physicians fear missing cases of infectious red legs and treat many patients unnecessarily with antibiotics.ObjectiveDevelop and validate easy-to-use diagnostic tools applicable at bedside of patients to orient diagnosis of the commonest and most serious causes of infectious red legs (non-necrotizing bacterial dermohypodermitis (NNBDH), and necrotizing fasciitis (NF)) versus the commonest inflammatory cause (eczema).MethodsWe collected data of patients presenting to our dermatology department from January first 2012 until May 17th 2017 with a diagnosis of red leg. Three models were developed using fast frugal trees. Validation was performed in a second cohort of patients.ResultsA total of 187 patients (mean age 56, SD = 21 years, 48.1% women) were included in the development phase and 62 patients (mean age 64, SD = 19, 52% women) in the validation phase. In the validation data set, sensitivity and specificity were respectively 67% and 91% for NNBDH, 83% and 66%, for NF and 88% and 93%, for eczema.ConclusionPresentations of suspected lower-limb infections are commonly misdiagnosed, resulting in avoidable antibiotic prescription and hospitalization. We developed an easy-to-use clinical diagnostic tool applicable at the bedside of patients to help orient physicians in certain situations and avoid unnecessary initiation of antibiotics. Future work should focus on validating this tool in primary care to minimize misdiagnosis of red legs and overprescription of antibiotics.
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  Data: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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  Data: &lt;i&gt;Keywords: &lt;/i&gt;lower extremity wound; pain &lt; wound assessment; photography &lt; wound; stasis ulcers &lt; lower extremity wound; wound assessment
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      – TitleFull: Red Leg Dilemma: Development and Validation of Clinical Decision Tools for Non-Necrotizing Bacterial Dermohypodermitis, Necrotizing Fasciitis, and Eczematous Dermatitis.
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