Incidence estimates for lichen planopilaris and frontal fibrosing alopecia in a New York City health care system.

Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are scarring alopecias that cause significant distress and psychological morbidity. Limited studies have been performed examining the epidemiology of FFA and LPP. We performed a retrospective case cohort analysis by querying for patients with the ICD 10 code L66.1 (LPP, FFA) between 2015 and 2018 using the Clinical Data Warehouse (CDW) at NewYork-Presbyterian Hospital and Columbia Doctors. We calculated the one-year incidence of LPP/FFA between January 1, 2018 to December 31, 2018 by identifying all patients without a previously recorded ICD code for L66.1 who presented as a new hair loss patient based on chart review. A total of 170 patients were identified with a new diagnosis of LPP or FFA in 2018 among 1,187,583 patients. The standardized incidence per 100,000 was 12.75 for LPP and FFA combined, 7.35 for LPP alone, and 5.41 for FFA alone. The incidence peaked in the 51 to 60 age range (3.36). The incidence was highest in non-Hispanic White patients (17.27), White patients of unknown ethnicity (26.26), and non-Hispanic Asian patients (17.27). In New York City, LPP and FFA are uncommon diseases that are most common in middle-aged females and non-Hispanic White patients.

Validation of Case Identification for Alopecia Areata Using International Classification of Diseases Coding.

BACKGROUND: Search algorithms used to identify patients with alopecia areata (AA) need to be validated prior to use in large databases. OBJECTIVES: The aim of the study is to assess whether patients with an International Statistical Classification of Diseases and Related Health Problems (ICD) 9 or 10 code for AA have a true diagnosis of AA. MATERIALS AND METHODS: A multicenter retrospective review was performed at Columbia University Irving Medical Center, Brigham and Women's Hospital, and Massachusetts General Hospital to determine whether patients with an ICD 9 codes (704.01 - AA) or ICD 10 codes (L63.0 -Alopecia Totalis, L63.1 - Alopecia Universalis, L63.2 - Ophiasis, L63.8 - other AA, and L63.9 - AA, unspecified) for AA met diagnostic criteria for the disease. RESULTS: Of 880 charts, 97.5% had physical examination findings consistent with AA, and 90% had an unequivocal diagnosis. AA was diagnosed by a dermatologist in 87% of the charts. The positive predictive value (PPV) of the ICD 9 code 704.01 was 97% (248/255). The PPV for the ICD 10 codes were 64% (75/118) for L63.0, 86% (130/151) for L63.1, 50% (1/2) for L63.2, 91% (81/89) for L63.8, and 93% (247/265) for L63.9. Overall, 89% (782/880) of patients with an ICD code for AA were deemed to have a true diagnosis of AA. CONCLUSIONS: Patients whose medical records contain an AA-associated ICD code have a high probability of having the condition.

Low Utilization of the Dermatology Ambulatory Encounter among Patients with Hidradenitis Suppurativa: A Population-Based Retrospective Cohort Analysis in the USA.

BACKGROUND: There are limited data evaluating the utilization of dermatologists for the care of patients with hidradenitis suppurativa. OBJECTIVE: To determine the utilization of the dermatology ambulatory encounter among hidradenitis suppurativa patients, and to evaluate whether utilization varies by insurance status. METHODS: This was a retrospective cohort analysis in an adult population sample of 42,030 hidradenitis suppurativa patients with either private or public health insurance who were identified by a validated scheme using SNOMED-CT terminology. The primary outcome was a dichotomous variable defined as having at least 1 ambulatory encounter with a dermatologist over a 3-year period. RESULTS: Overall, 21.8% (9,170/42,020) of the hidradenitis suppurativa patients had at least 1 ambulatory encounter with a dermatologist. This proportion did not significantly vary between patients with private insurance (22%), Medicaid (21.6%), and Medicare (21.7%). CONCLUSION: Utilization of the ambulatory dermatology encounter among patients with hidradenitis suppurativa is low in the USA. Factors other than insurance status influence this level of utilization.

Sex- and Age-Adjusted Population Analysis of Prevalence Estimates for Hidradenitis Suppurativa in the United States.

Importance: The true prevalence of hidradenitis suppurativa (HS) is unknown. Objective: To establish standardized overall and group-specific prevalence estimates for HS in the United States. Design, Setting, and Participants: This retrospective analysis included a demographically heterogeneous population-based sample of more than 48 million unique patients across all US census regions. As of October 27, 2016, a total of 47 690 patients with HS were identified using electronic health record data. Main Outcomes and Measures: Standardized overall point prevalence for HS and sex-, age-, and race-specific prevalence estimates of HS in the general US population. Results: Of the 47 690 patients with HS (26.2% men and 73.8% women), the overall HS prevalence in the US population sample was 0.10%, or 98 per 100 000 persons (95% CI, 97-99 per 100 000 persons). The adjusted prevalence in women was 137 per 100 000 (95% CI, 136-139 per 100 000), more than twice that of men (58 per 100 000; 95% CI, 57-59 per 100 000; P < .001). The prevalence of HS was highest among patients aged 30 to 39 years (172 per 100 000; 95% CI, 169-275 per 100 000) compared with all other age groups (range, 15-150 per 100 000; P < .001). Adjusted HS prevalences among African American (296 per 100 000; 95% CI, 291-300 per 100 000) and biracial (218 per 100 000; 95% CI, 202-235 per 100 000) patients were more than 3-fold and 2-fold greater, respectively, than that among white patients (95 per 100 000; 95% CI, 94-96 per 100 000; P < .001). Conclusions and Relevance: Hidradenitis suppurativa is an uncommon, but not rare, disease in the United States that disproportionately affects female patients, young adults, and African American and biracial patients.

Clinical Factors Associated with Readmission among Patients with Lower Limb Cellulitis.

BACKGROUND: There is substantial allocation of resources directed towards evaluation and management of lower limb cellulitis (LLC) in the acute care setting. Readmission for LLC is poorly understood, and there is little evidence with which to identify patients at risk for readmission. OBJECTIVE: To describe demographics, comorbidities, admission vital signs, and laboratory markers of infection among patients with LLC who are readmitted, and to investigate which among these factors is associated with readmission. METHODS: A cross-sectional retrospective cohort study was performed at tertiary and community hospitals within a regional health care system in order to summarize readmission characteristics. Univariate and multivariate models were created to estimate the likelihood of independent variables being associated with LLC readmission. RESULTS: The readmission rate was 11.2% with a median age of 68.6 years for the cohort. Increased age and subsidized insurance were associated with more frequent admissions. For every 10-year age increase, cellulitis subjects had a 14% increase in readmission odds (OR 1.14, CI 1.07-1.20). Patients with subsidized insurance had an almost twofold increased risk (OR 1.88, CI 1.42-2.50). Smoking, obesity, hypertension, diabetes mellitus, renal insufficiency, tachycardia, hypotension, leukocytosis, and neutrophilia were not more frequent in readmitted patients. CONCLUSIONS: Older age and subsidized insurance were associated with readmission whereas severity indicators for infection including abnormal vital signs and laboratory markers were not significantly associated. Factors other than severity of infection, such as socioeconomic factors, may influence clinical decisions related to readmission for LLC.

Incidence of hidradenitis suppurativa in the United States: A sex- and age-adjusted population analysis.

BACKGROUND: The true incidence of hidradenitis suppurativa (HS) is unknown. OBJECTIVE: To determine standardized incidence estimates for HS in the United States. METHODS: We used a retrospective cohort analysis, including incident HS cases identified using electronic health records data for a demographically heterogeneous population-based sample of >48 million unique patients across all 4 census regions. We calculated standardized 1- and 10-year cumulative incidences for the overall population and for sex-, age-, and race-specific groups. RESULTS: There were 5410 new HS diagnoses over a 1-year period, with an incidence of 11.4 (95% confidence interval [CI], 11.1-11.8) cases per 100,000 population. One-year incidence in women was 16.1 (95% CI, 15.5-16.6) per 100,000, more than twice that of men [6.8 (95% CI, 6.5-7.2) per 100,000; P < .0001]. Age group-specific incidence was highest among patients 18 to 29 years of age [22.0 (95% CI, 21.0-23.2) per 100,000]. Incidence among African Americans [30.6 (95% CI, 29.1-32.2) per 100,000] was >2.5 times that of whites [11.7 (95% CI, 11.3-12.2) per 100,000; P < .0001]. The average annual overall incidence over 10 years was 8.6 (95% CI, 8.6-8.7) per 100,000 population. LIMITATIONS: The use of deidentified claims prevented validation for a larger case subset. CONCLUSION: HS incidence has increased over the past decade and disproportionately involves women, young adults, and African Americans.

Clinical characteristics associated with days to discharge among patients admitted with a primary diagnosis of lower limb cellulitis.

BACKGROUND: Clinicians have limited ability to classify risk of prolonged hospitalization among patients with lower limb cellulitis. OBJECTIVE: We sought to identify characteristics associated with days to discharge and prolonged stay. METHODS: We conducted retrospective cohort analysis including patients admitted with a primary diagnosis of lower limb cellulitis at community and tertiary hospitals. RESULTS: There were 4224 admissions for lower limb cellulitis among 3692 patients. Mean age of the cohort was 64.4 years. Frequencies of tobacco smoking, obesity, and diabetes mellitus were 25.1%, 44.9%, and 19.3%, respectively. Patients having decreased likelihood of discharge included those with the following: 10-year age increments 0.90 (95% confidence interval [CI] 0.88-0.92), obesity 0.90 (95% CI 0.83-0.97), diabetes mellitus 0.90 (95% CI 0.82-0.98), tachycardia 0.76 (95% CI 0.67-0.85), hypotension 0.77 (95% CI 0.65-0.90), leukocytosis 0.86 (95% CI 0.79-0.93), neutrophilia 0.80 (95% CI 0.73-0.87), elevated serum creatinine 0.74 (95% CI 0.68-0.81), and low serum bicarbonate 0.84 (95% CI 0.75-0.95). LIMITATIONS: This analysis is retrospective and based on coded data. Unknown confounding variables may also influence prolonged stay. CONCLUSIONS: Patients with lower limb cellulitis and prolonged stay have a number of clinical characteristics which may be used to classify risk for prolonged stay.

Perceptual learning of orientation judgments in oblique meridians.

Fourteen daily training sessions in orientation discrimination of foveal lines in the 45-deg meridian improved thresholds in the trained meridian by an average of 25 % in five observers. A substantial amount of training transferred to the other obliques, but none to the cardinal meridians, with a consequent reduction in the oblique effect. The data were interpreted as showing perceptual learning at two levels: performance facilitation specific to the trained orientation and improved proficiency globally. The failure of the cardinal orientations to share in the benefit is likely to have its origin in the fact that contour orientation in these meridians is so well established that it had already reached maximum hyperacuity thresholds. The judgment of obliques depends much more than the judgment of cardinals on whether the comparison and test stimuli are shown simultaneously or in succession, but this effect is not changed by perceptual training.