{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T10:39:59Z","timestamp":1790073599945,"version":"4.0.1"},"reference-count":20,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Dermatol"],"published-print":{"date-parts":[[2024,5,1]]},"abstract":"<jats:sec id=\"ab-doi240003-4\"><jats:title>Importance<\/jats:title><jats:p>Cellulitis is misdiagnosed in up to 30% of cases due to mimic conditions termed <jats:italic>pseudocellulitis<\/jats:italic>. The resulting overuse of antibiotics is a threat to patient safety and public health. Surface thermal imaging and the ALT-70 (asymmetry, leukocytosis, tachycardia, and age \u226570 years) prediction model have been proposed as tools to help differentiate cellulitis from pseudocellulitis.<\/jats:p><\/jats:sec><jats:sec id=\"ab-doi240003-5\"><jats:title>Objectives<\/jats:title><jats:p>To validate differences in skin surface temperatures between patients with cellulitis and patients with pseudocellulitis, assess the optimal temperature measure and cut point for differentiating cellulitis from pseudocellulitis, and compare the performance of skin surface temperature and the ALT-70 prediction model in differentiating cellulitis from pseudocellulitis.<\/jats:p><\/jats:sec><jats:sec id=\"ab-doi240003-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This prospective diagnostic validation study was conducted among patients who presented to the emergency department with acute dermatologic lower extremity symptoms from October 11, 2018, through March 11, 2020. Statistical analysis was performed from July 2020 to March 2021 with additional work conducted in September 2023.<\/jats:p><\/jats:sec><jats:sec id=\"ab-doi240003-7\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>Temperature measures for affected and unaffected skin were obtained. Cellulitis vs pseudocellulitis was assessed by a 6-physician, independent consensus review. Differences in temperature measures were compared using the <jats:italic>t<\/jats:italic> test. Logistic regression was used to identify the temperature measure and associated cut point with the optimal performance for discriminating between cellulitis and pseudocellulitis. Diagnostic performance characteristics for the ALT-70 prediction model, surface skin temperature, and both combined were also assessed.<\/jats:p><\/jats:sec><jats:sec id=\"ab-doi240003-8\"><jats:title>Results<\/jats:title><jats:p>The final sample included 204 participants (mean [SD] age, 56.6 [16.5] years; 121 men [59.3%]), 92 (45.1%) of whom had a consensus diagnosis of cellulitis. There were statistically significant differences in all skin surface temperature measures (mean temperature, maximum temperature, and gradients) between cellulitis and pseudocellulitis. The maximum temperature of the affected limb for patients with cellulitis was 33.2 \u00b0C compared with 31.2 \u00b0C for those with pseudocellulitis (difference, 2.0 \u00b0C [95% CI, 1.3-2.7 \u00b0C]; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001). The maximum temperature was the optimal temperature measure with a cut point of 31.2 \u00b0C in the affected skin, yielding a mean (SD) negative predictive value of 93.5% (4.7%) and a sensitivity of 96.8% (2.3%). The sensitivity of all 3 measures remained above 90%, while specificity varied considerably (ALT-70, 22.0% [95% CI, 15.8%-28.1%]; maximum temperature of the affected limb, 38.4% [95% CI, 31.7%-45.1%]; combination measure, 53.9% [95% CI, 46.5%-61.2%]).<\/jats:p><\/jats:sec><jats:sec id=\"ab-doi240003-9\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>In this large diagnostic validation study, significant differences in skin surface temperature measures were observed between cases of cellulitis and cases of pseudocellulitis. Thermal imaging and the ALT-70 both demonstrated high sensitivity, but specificity was improved by combining the 2 measures. These findings support the potential of thermal imaging, alone or in combination with the ALT-70 prediction model, as a diagnostic adjunct that may reduce overdiagnosis of cellulitis.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamadermatol.2024.0091","type":"journal-article","created":{"date-parts":[[2024,3,27]],"date-time":"2024-03-27T15:34:25Z","timestamp":1711553665000},"page":"511","source":"Crossref","is-referenced-by-count":16,"title":["Validation of Thermal Imaging and the ALT-70 Prediction Model to Differentiate Cellulitis From Pseudocellulitis"],"prefix":"10.1001","volume":"160","author":[{"given":"Michael S.","family":"Pulia","sequence":"first","affiliation":[{"name":"BerbeeWalsh Department of Emergency Medicine, University of Wisconsin\u2013Madison School of Medicine and Public Health, Madison"},{"name":"Department of Industrial and Systems Engineering, University of Wisconsin\u2013Madison School of Engineering, Madison"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca J.","family":"Schwei","sequence":"additional","affiliation":[{"name":"BerbeeWalsh Department of Emergency Medicine, University of Wisconsin\u2013Madison School of Medicine and Public Health, Madison"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roxana","family":"Alexandridis","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Medical Informatics, University of Wisconsin\u2013Madison School of Medicine and Public Health, Madison"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael R.","family":"Lasarev","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Medical Informatics, University of Wisconsin\u2013Madison School of Medicine and Public Health, Madison"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward","family":"Harwick","sequence":"additional","affiliation":[{"name":"BerbeeWalsh Department of Emergency Medicine, University of Wisconsin\u2013Madison School of Medicine and Public Health, Madison"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Glinert","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University of Wisconsin\u2013Madison School of Medicine and Public Health, Madison"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ambar","family":"Haleem","sequence":"additional","affiliation":[{"name":"Division of Infectious Disease, Department of Medicine, University of Wisconsin\u2013Madison School of Medicine and Public Health, Madison"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie","family":"Hess","sequence":"additional","affiliation":[{"name":"BerbeeWalsh Department of Emergency Medicine, University of Wisconsin\u2013Madison School of Medicine and Public Health, Madison"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas D.","family":"Keenan","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University of Wisconsin\u2013Madison School of Medicine and Public Health, Madison"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph A.","family":"McBride","sequence":"additional","affiliation":[{"name":"Division of Infectious Disease, Department of Medicine, University of Wisconsin\u2013Madison School of Medicine and Public Health, Madison"},{"name":"Division of Infectious Disease, Department of Pediatrics, University of Wisconsin\u2013Madison School of Medicine and Public Health, Madison"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Redwood","sequence":"additional","affiliation":[{"name":"BerbeeWalsh Department of Emergency Medicine, University of Wisconsin\u2013Madison School of Medicine and Public Health, 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