Access to POEMs and Essential Evidence Plus will no longer be included in CMA membership as of Dec. 1, 2023.
Clinical Question
Does compression reduce the likelihood of recurrent cellulitis in persons with chronic leg edema?
Bottom line
Adding compression to education reduces the likelihood of recurrent cellulitis in patients with chronic leg edema. 1b-
Reference
Study design: Randomized controlled trial (nonblinded)
Funding: Foundation
Setting: Inpatient (any location)
Synopsis
These researchers screened 183 adults and ultimately identified 84 who met their inclusion criteria. The included patients had edema for at least 3 months and had experienced 2 or more episodes of cellulitis in the same leg during the previous 2 years. Persons who were unstable or receiving end-of-life care, who had a chronic wound requiring ongoing treatment, or who were already wearing compression garments were excluded. Patients were randomized to receive either education only, or education plus a compression garment. The garments were mostly knee-high compression stockings that included the foot but not necessarily the toes. The primary outcome was the number of episodes of recurrent cellulitis, diagnosed by a physician not otherwise involved with the study (although it isn't clear whether the diagnosing physician was masked to the intervention). Groups were balanced at the beginning of the study, with a mean age of 64 years, 49% women, and with 63% having had edema for more than 5 years. Analysis was by intention to treat, and patients were no longer followed after an episode of cellulitis occurred. The trial was stopped early when an interim analysis revealed that episodes of cellulitis were much less common in the compression group (15% vs 40%; P = .002; number needed to treat [NNT] = 4). At that time, the median duration of follow-up was 209 days in the compression group and 77 days in the education-only group. Fewer patients in the compression group were hospitalized for cellulitis (3 vs 6). A lymphedema quality-of-life score also improved more in the intervention group, though broader quality-of-life scores did not improve.
Reviewer
Mark H. Ebell, MD, MS
Professor
University of Georgia
Athens, GA
Comments
Compression stockings
Undervalued & underused by many clinicians & patients. How do we change that culture?
what a marvellous paper
Most studies seem to have marginal gains but this is a simple option that produces early results.
Compression stockings
Referral to an Endovascular surgeon also has a place in this management when varicose veins are involved. The latest outpatient procedures can bring about a dramatic improvement. The Canadian Healthcare program does not, however, at present, provide adequate service in this regard.
No
Compression stocking has improved many cases with recurrent cellulitis, few who can’t afford to buy the stockings, tensor bandage did the same job .
Common issue
Good information
As above
Ditto