Epidemiologic Characteristics of Patients Admitted to Emergency Department with Dermatological Complaints; a Retrospective Cross sectional Study

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Abstract

Introduction:

Dermatological diseases constitute 5-8% of all emergency department (ED) visits. However, little is known about these patients. The aim of this study is to determine the epidemiologic characteristics of patients admitted to ED with dermatological complaints.

Methods:

This is a retrospective cross-sectional study conducted in the ED of a university hospital. Patients over 18 years of age who presented to ED with the following complaints were included in the study: rash, pruritus, and edema sensation in the throat or shortness of breath due to an allergic reaction. Demographics, chief complaints, final diagnoses, triage categories, consultations and hospitalization rates were obtained through computerized database of the hospital.

Results:

859 patients were included in the final analysis. 511 (59.5%) patients were female and the mean age of patients was 39.03±15 years. The most common complaint and final diagnosis were skin rash with pruritus (50.9%) and urticaria with drug eruptions (84.5%), respectively. Two patients (0.2%) had an emergent triage category. 804 (93.6%) patients were discharged from ED, while 55 (6.4%) received consultations, resulting in 19 (34.5%) hospitalizations.

Conclusion:

Most of the patients admitted to ED with dermatological complaints are non-urgent and can be treated as outpatients. However, physicians should be alert for emergent causes, as well.

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Most cited references 18

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Nonurgent patients in emergency departments: rational or irresponsible consumers? Perceptions of professionals and patients

Anne-Claire Durand, Sylvie Palazzolo, Nicolas Tanti-Hardouin … (2012)

Background For several decades, overcrowding in emergency departments (EDs) has been intensifying due to the increased number of patients seeking care in EDs. Demand growth is partly due to misuse of EDs by patients who seek care for nonurgent problems. This study explores the reasons why people with nonurgent complaints choose to come to EDs, and how ED health professionals perceive the phenomenon of “nonurgency”. Results Semi-structured interviews were conducted in 10 EDs with 87 nonurgent patients and 34 health professionals. Interviews of patients revealed three themes: (1) fulfilled health care needs, (2) barriers to primary care providers (PCPs), and (3) convenience. Patients chose EDs as discerning health consumers: they preferred EDs because they had difficulties obtaining a rapid appointment. Access to technical facilities in EDs spares the patient from being overwhelmed with appointments with various specialists. Four themes were identified from the interviews of health professionals: (1) the problem of defining a nonurgent visit, (2) explanations for patients’ use of EDs for nonurgent complaints, (3) consequences of nonurgent visits, and (4) solutions to counter this tendency. Conclusions Studies on the underlying reasons patients opt for the ED, as well as on their decision-making process, are lacking. The present study highlighted discrepancies between the perceptions of ED patients and those of health professionals, with a special focus on patient behaviour. To explain the use of ED, health professionals based themselves on the acuity and urgency of medical problems, while patients focused on rational reasons to initiate care in the ED (accessibility to health care resources, and the context in which the medical problem occurred). In spite of some limitations due to the slightly outdated nature of our data, as well as the difficulty of categorizing nonurgent situations, our findings show the importance of conducting a detailed analysis of the demand for health care. Understanding it is crucial, as it is the main determining factor in the utilization of health care resources, and provides promising insights into the phenomenon of ED usage increase. For reforms to be successful, the process of decision-making for unscheduled patients will have to be thoroughly investigated.

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Most common dermatologic problems identified by internists, 1990-1994.

Z Feldman, Joseph McConnell, A Fleischer … (1998)

Internists in all settings see many patients with skin conditions. Thus, their education in dermatology is important. Information on which areas of dermatology are most commonly seen in internal medicine practices is necessary for designing effective educational programs on skin disease. To determine what types of dermatologic problems internists most commonly diagnose. National Ambulatory Medical Care Survey data from 1990 to 1994 were analyzed for dermatologic diagnoses. Physicians specializing in internal medicine and all its subspecialties were compared with dermatologists and with other physicians. The most common skin disorders diagnosed by internists were dermatitis (15.8% of all diagnoses) and bacterial skin infections (14.0% of all diagnoses). Combined, bacterial, fungal, and viral infections included 28.3% of the most common dermatologic diagnoses made by internists. The top 10 most common diagnoses accounted for 57.9% of all skin-related diagnoses and the top 20 most common diagnoses accounted for 72.8%. Internists were more likely to see patients for bacterial skin infections, herpes infection, exanthem, urticaria, and insect bites while dermatologists more commonly saw patients for actinic and seborrheic keratoses, warts, benign and malignant skin tumors, and psoriasis. The most common dermatologic diseases diagnosed by internists differ considerably from those diagnosed by dermatologists. Because dermatologists do much of the dermatology teaching of internal medicine residents, it is important to recognize these differences to place emphasis on the proper areas of study. Some common or serious skin conditions not often diagnosed by internists such as psoriasis and melanoma also deserve attention in internal medicine training programs.

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Cutaneous Conditions Leading to Dermatology Consultations in the Emergency Department

Alexander Jack, Allyson Spence, Benjamin J. Nichols … (2011)

Introduction We established the most common cutaneous diseases that received dermatology consultation in the adult emergency department (ED) and identified differentiating clinical characteristics of dermatoses that required hospital admission. Methods A retrospective chart review of 204 patients presenting to the ED who received dermatology consultations at Los Angeles County/University of Southern California Medical Center, an urban tertiary care teaching hospital. Results Of all patients, 18% were admitted to an inpatient unit primarily for their cutaneous disease, whereas 82% were not. Of nonadmitted patients, the most commonly diagnosed conditions were eczematous dermatitis not otherwise specified (8.9%), scabies (7.2%), contact dermatitis (6.6%), cutaneous drug eruption (6.0%), psoriasis vulgaris (4.2%), and basal cell carcinoma (3.6%). Of patients admitted for their dermatoses, the most highly prevalent conditions were erythema multiforme major/Stevens-Johnson syndrome (22%), pemphigus vulgaris (14%), and severe cutaneous drug eruption (11%). When compared with those of nonadmitted patients, admitted skin conditions were more likely to be generalized (92% vs 72%; P = 0.0104), acute in onset (<1 month duration) (81% vs 51%; P = 0.0005), painful (41% vs 15%; P = 0.0009), blistering (41% vs 7.8%; P < 0.0001), and ulcerated or eroded (46% vs 7.8%; P < 0.0001). They were more likely to involve the mucosa (54% vs 7.2%; P < 0.0001) and less likely to be pruritic (35% vs 58%; P = 0.0169). Conclusion We have described a cohort of patients receiving dermatologic consultation in the ED of a large urban teaching hospital. These data identify high-risk features of more severe skin disease and may be used to refine curricula in both emergency and nonemergency cutaneous disorders for emergency physicians.

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Author and article information

Journal

Journal ID (nlm-ta): Arch Acad Emerg Med

Journal ID (iso-abbrev): Arch Acad Emerg Med

Journal ID (publisher-id): AAEM

Title: Archives of Academic Emergency Medicine

Publisher: Shahid Beheshti University of Medical Sciences (Tehran, Iran )

ISSN (Electronic): 2645-4904

Publication date Collection: 2019

Publication date (Electronic): 19 August 2019

Volume: 7

Issue: 1

Electronic Location Identifier: e47

Affiliations

[1 ]Department of Emergency Medicine, Kepez State Hospital, Antalya, Turkey.

[2 ]Department of Emergency Medicine, Faculty of Medicine, Akdeniz University, Antalya, Turkey.

[3 ]Department of Emergency Medicine, Antalya Education and Research Hospital, Antalya, Turkey.

[4 ]Department of Emergency Medicine, Ömer Halisdemir University Education and Research Hospital, Nigde, Turkey.

[5 ]Department of Dermatology, Faculty of Medicine, Akdeniz University, Antalya, Turkey.

Author notes

[* ]Corresponding author: Name: Ozlem Yigit; Department of Emergency Medicine, Faculty of Medicine,Akdeniz University, Dumlupinar Bulvari, Antalya, Turkey. E-mail: ozlemyigit@akdeniz.edu.tr, Tel: +90505 644 42 86

Article

Publisher ID: aaem-7-e47

PMC ID: 6785214

SO-VID: c4dd8ff0-9671-406a-9650-f2376e4af6e8

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License, ( http://creativecommons.org/licenses/by/3.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Epidemiologic Characteristics of Patients Admitted to Emergency Department with Dermatological Complaints; a Retrospective Cross sectional Study

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Abstract

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Preventive and Emergency Medicine Insights

Most cited references 18

Nonurgent patients in emergency departments: rational or irresponsible consumers? Perceptions of professionals and patients

Most common dermatologic problems identified by internists, 1990-1994.

Cutaneous Conditions Leading to Dermatology Consultations in the Emergency Department

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