Clinically Useless

Patients with uncomplicated cellulitis frequently undergo blood culture and imaging, despite recommendations against routine use of such testing, finds a retrospective study in JAMA Internal Medicine. And the economic toll is significant.

Researchers examined the medical records of 183 patients seen at one emergency department with presumed uncomplicated cellulitis who were subsequently admitted. One third had blood cultures (with growth detected in 1 patient), but culture was deemed appropriate according to clinical guidelines in just 10% of the overall cohort. Additionally, nearly 70% underwent imaging (e.g., ultrasound, radiograph), and none of these tests were considered appropriate.

The researchers estimate that the national cost of “these largely clinically useless diagnostic studies” exceeds $225 million annually. They note that guidelines from the Infection Diseases Society of American recommend against imaging unless patients also have febrile neutropenia, and against culture unless patients are severely immunocompromised, show systemic toxic effects, or have had an animal bite.

My Take:
This is why we have the most expensive health care system in the world that ranks among the worst of all industrialized nations. The “standard of care” seemingly is only applied by physicians when it suits their purpose. Unfortunately, too often the goal is money.



Cellulitis is a bacterial infection of the inner layers of the skin. Signs and symptoms include an area of redness that increases over the course of a few days. The borders of the redness are usually not sharp and the skin may be swollen. The area often will turn white when pressure is applied, but not always. The area of infection is usually painful and warm to the touch. The person may have a fever or feel tired. The legs and the face are the most common sites although cellulitis can occur in any part of the body.

My mother-in-law is currently being treated for cellulitis following a second knee joint replacement. A simple course of antibiotics has been effective, prescribed based on the physical findings rather than any elaborate testing. This is the recommended standard of care. In her case, the lack of available testing at rehab may have guided the treatment. In a hospital setting, the equipment is there and must be paid for, so let’s run the tests.

The Bottom Line:
Over the course of your life, on average, 80% of your health care costs will be for testing, not treatment. Additionally, 80% of the total health care costs during your lifetime will be spent during the last six weeks of your life, again mostly for “clinically useless” testing.

Source: April 7, 2018 New England Journal of Medicine