Over three quarters of dermatologic complaints seen in the emergency department are acute in nature, researchers reported at the 23rd European Academy of Dermatology and Venereology Congress.
Priyanka Vedak, with Massachusetts General Hospital in Boston, MA, and colleagues conducted a study in order to evaluate the dermatologic diagnoses assessed in their emergency department (ED) and also to examine the use of dermatology consultations.
Patients often seek care in the ED for cutaneous conditions, either because of severity or accessibility, Vedak noted. About a decade ago, the direct cost of ED visits for skin conditions was estimated at $623 million dollars. Even so, there is scant information about the nature and outcome of these visits.
Earlier studies that have assessed dermatologic diagnoses in the hospital or ED setting have primarily focused on pediatric patients and also on patients in whom a dermatologic consultation was requested, she added.
Notably, the present study included both pediatric and adult cases, and addressed both consulted case and cases in which physicians independently diagnosed and managed dermatologic conditions.
Of 733 ED visits reviewed in the present series, 83.5% were for acute dermatologic complaints (less than 4 weeks), and 12.5% were for chronic dermatologic complaints (more than 4 weeks). The acuity of the dermatologic complaint was not recorded in 4% of patients.
In most cases, the dermatologic complaint was the primary complaint.
The most common dermatologic complaints were diagnostically unclear. They were documented as rash not otherwise specified (NOS) in 13.6% of cases followed by those that were urticarial in nature (12.9%). The term “rash NOS” referred to cases in which no diagnosis was proposed or cases in which at least four diagnoses were proposed.
Only about a third (35%) of patients diagnosed with “rash NOS,” underwent additional dermatologic evaluation or had a dermatology follow-up visit. Overall, 14% of cases presenting to the ED that involved a dermatologic diagnosis received dermatologic input in the form of either a consultation or outpatient follow-up visit.
Of ED cases that were referred for outpatient follow-up with a dermatologist, there was a 49% rate of agreement between the ED team’s proposed diagnosis and the dermatologist’s proposed diagnosis.
Vedak cited the study’s retrospective design as a possible limitation. Also, the study examined only 6 months of ED visits and may thus have failed to capture seasonal variations in dermatologic complaints presenting to the ED.
The investigators were also unable to assess the incidence or outcomes of subsequent dermatology follow-up conducted at outside hospitals.
Vedak said she hopes the information provided by the study will help “tailor” the cutaneous curriculum of ED trainees.
Jill Stein is a Paris-based freelance medical writer.