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Comment & Response
August 2018

The Hindsight Problem in Evaluating the Value of Ultrasounds in Cellulitis—Reply

Author Affiliations
  • 1Department of Dermatology, Massachusetts General Hospital, Harvard University, Boston
  • 2Harvard Combined Dermatology Residency, Harvard Medical School, Boston, Massachusetts
JAMA Intern Med. 2018;178(8):1141-1142. doi:10.1001/jamainternmed.2018.3240

In Reply We thank Cho et al for their letter to the editor and are grateful for the opportunity to discuss the important points raised therein. Given the word limit of our original article, we were not able to elaborate on this important subject matter and appreciate the opportunity to more clearly elucidate the methodology on where and how the “presumed diagnosis of cellulitis” was determined. We retrospectively analyzed the results of a larger prospective study performed in the emergency department and internal medicine units.1 The cohort included patients who had been evaluated and suspected of having cellulitis by an emergency department physician prior to admission, rather than patients identified by an International Classification of Diseases code of cellulitis. We agree that a retrospective analysis of patients who had International Classification of Diseases codes for cellulitis following hospitalization would present a biased view of the population and their subsequent imaging. Thus, in this study, the patients who received imaging were already suspected of having cellulitis at the time of imaging.

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