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New tool indicates when IV antibiotics are needed for cellulitis in children

Researchers have developed The Melbourne ASSET Score, a clinical scoring system for children with cellulitis that is designed to improve how intravenous (IV) antibiotics are prescribed in this patient population. The authors say the system will likely reduce the over-prescription of antibiotics as well as the undertreatment of cellulitis, which can lead to more severe infections (Pediatrics Jan. 3, 2019).

“The Melbourne ASSET Score is fast, easy to use by anyone, and does not need blood or other expensive tests. And it can [also] be used in any skin colour. Now that we have designed and validated the Score, the next step is to assess the impact of using it in different settings,” said lead author Dr. Laila F. Ibrahim, a pediatrician at The Royal Children’s Hospital Melbourne in Australia, in a video abstract.

The Melbourne ASSET Score guides physicians through their diagnostic process by using the word “Asset” as an acronym for symptoms to look for and assess:

A: Area

S: Systemic features

S: Swelling

E: Eye

T: Tenderness

The Melbourne ASSET Score can be used to prevent the worsening of cellulitis symptoms.

Public domain photo from

The severity of these features are given a score that can determine if IV therapy is needed. Researchers noted that a cut-off score of four to start IV antibiotics yielded the highest correct classification of 80% of patients (sensitivity 60%; specificity 93%). This score was validated in 251 children and maintained a robust area under the curve of 0.83 (95% confidence interval 0.78–0.89). The test has a maximum score of seven.

A prospective cohort study of children aged six months to 18 years admitted to The Royal Children’s Hospital Melbourne from Jan. 2014 to Aug. 2017 was conducted in order to create The Melbourne ASSET Score. Patients were divided into two groups based on route of administration of antibiotics at 24 hours (the predetermined gold standard). Investigators also compared demographics and clinical features. Then, clinicians who treated the patients were surveyed about the features they used to decide whether to start their patients on IV antibiotics. Finally, combinations of differentiating features were plotted on receiver operating characteristic curves.

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