ABSTRACT
OBJECTIVE: To characterize and analyze the inpatient and emergency pediatric dermatology consults in our academic hospital center. METHODS: We reviewed 485 consultations that were done by the University of Puerto Rico Department of Dermatology from July 2007 to June 2012. The date, patient age and gender, consulting service, presumptive diagnosis, final diagnosis, and diagnostic procedures performed were documented for each consult. RESULTS: The patients' ages ranged from newborn to 18 years; the 13 to 18 years age group was the most common (29%). Dermatology consults were requested by the general pediatrics ward, primarily (32%), followed by the emergency room (25%). In 236 cases (48.6%), a vague diagnostic impression was provided by the consulting service, whereas in 249 (51.4%) cases, a specific or differential diagnosis was provided. The dermatology service changed the diagnosis in 12% (58/249) of the evaluated cases. The most common misdiagnoses were allergic contact dermatitis, drug eruption, papular urticaria, nutritional deficiency, atopic dermatitis, seborrheic dermatitis, cellulitis, and herpes infection. The most common diagnoses encountered were inflammatory skin conditions, infectious diseases, and drug eruptions. Skin biopsy was the most common procedure performed. In 30% of the cases, more than 1 procedure was performed as part of the evaluation work-up. CONCLUSION: Our study demonstrates the important role of the dermatologist in the diagnosis and management of pediatric patients with dermatological diseases. The information contained within this manuscript should contribute to raising the awareness of pediatricians regarding the most common dermatological diagnoses in this patient population.
Subject(s)
Dermatologists/organization & administration , Dermatology/statistics & numerical data , Emergency Service, Hospital/statistics & numerical data , Skin Diseases/epidemiology , Academic Medical Centers , Adolescent , Biopsy , Child , Child, Preschool , Diagnosis, Differential , Diagnostic Errors/statistics & numerical data , Female , Humans , Infant , Infant, Newborn , Inpatients , Male , Physician's Role , Puerto Rico , Retrospective Studies , Skin Diseases/diagnosis , Skin Diseases/physiopathologyABSTRACT
OBJECTIVE: There are few studies documenting dermatological consultations in the emergency setting. The aim of this study was to evaluate the nature, purpose, and diagnostic accuracy of emergency care physicians in all the dermatology consults evaluated by the Department of Dermatology of the University of Puerto Rico School of Medicine. METHODS: A retrospective analysis of all the consultation reports pertaining to patients evaluated at 4 emergency departments served from July 1, 2007, to June 30, 2013. The data collected from each consultation report consisted of the demographic information of the patient, the name of the consulting hospital, the initial diagnostic impression, the diagnostic impression of a dermatologist, and the procedures, if any, performed by that dermatologist. RESULTS: A total of 429 patients were evaluated (53% men, 47% women) from July 2007 through June 2013. The most common diagnosis was infectious process (37%), followed by eczema (14%) and drug-induced skin reactions (12%). Seventeen percent (17%) of the cases for which consultations were sought were considered true dermatological emergencies. Forty-six percent of cases resulted in no diagnostic impression from the consulting physician. Of the cases that did result in diagnoses, these diagnoses were later changed by a dermatologist in 34% of the cases. CONCLUSION: This study suggests that the role of the dermatologist in the emergency department is very important. In addition, better education in the management of common skin disorders and the identification of true dermatological emergencies should be stressed during medical school and in residency training programs of specialties such as emergency medicine and those that offer primary care.