[Interest of emergency dermatological consultation in a regional hospital]

Dermatological Emergency Cases in Geriatric Patients: A 3-year Multicenter Study of Three National Referral Hospitals in Indonesia

BACKGROUND: Dermatological emergency is a condition requiring immediate identification and treatment to reduce mortality and morbidity. There are several dermatoses resulting in emergency room (ER) visits frequently demonstrated by the geriatric population. However, there is a lack of data about elderly with dermatological presentation seen at the ER in Indonesia. AIM: This retrospective study aims to identify the prevalence of dermatological emergency cases in the elderly at three national referral hospitals in Indonesia within 3 years. METHODS: The sample was geriatric patients who came and/or were consulted by the ER to dermatology and venereology (DV) department. The data (e.g., age, sex, history taking, physical findings, and diagnoses) were collected from medical record from each hospital and presented as a descriptive data. RESULTS: This study showed that there were only 37% of all geriatric emergency dermatological consultations from 2017 to 2020. CONCLUSION: This study concluded that there were more than half non-emergent cases of 3-year period consultation. This condition may raise the need of better training about true emergency and standardized curricula of emergency dermatological presentations in geriatric patients.

Emergency Consultations in Dermatology in a Secondary Referral Hospital in Southern Switzerland: A Prospective Cross-Sectional Analysis

BACKGROUND/AIMS

The spectrum of dermatological emergencies is broad. Only a few studies have assessed the profile of dermatological conditions resulting in an emergency visit in a referral hospital. We sought to assess the conditions prompting an urgent dermatological visit and to compare the diagnoses with those made during the regular scheduled encounters.

METHODS

We performed a cross-sectional study of all patients with a cutaneous problem attending our emergency consultation during a 7-month period. The study variables were gender, age, duration of symptoms, diagnosis, need for hospitalization and/or follow-up. We further evaluated patients attending scheduled visits to compare the demographic characteristics and diagnoses between the two groups.

RESULTS

Six hundred fifty-two consecutive patients with an urgent dermatological consultation were included. Three hundred sixty (55.2%) were women and 292 (44.8%) were men. Infectious diseases (32.8%) as well as various forms of eczema (24.8%) constituted the most frequent causes for an emergency visit. Approximately 40% of emergency visits took place more than 1 week after the development of the cutaneous manifestations. The most frequent disorders seen in the 1,738 control patients included benign melanocytic and nonmelanocytic tumors (27.2%) and malignant skin lesions (11.5%).

CONCLUSIONS

Our study indicates that the dermatological diagnoses in the emergency visits significantly differ from those of the routinely scheduled appointments. In a significant portion of patients, the use of an emergency consultation was not justified. This study provides support to the idea that a specific training is required to manage dermatological emergencies and that efforts should be made to reduce unjustified emergency visit use.

Infectious skin disorders encountered in a pediatric emergency department of a tertiary care hospital in Argentina: a descriptive study

BACKGROUND

Infectious skin disorders (ISDs) are commonly seen in pediatric emergency departments (PED), however the exact frequency is unknown. We provide an accurate evaluation of the incidence and characteristics of ISDs diagnosed in a PED from Buenos Aires, Argentina, over a 1-year period.

METHODS

Prospectively, descriptive study of children evaluated in the PED with ISDs during 2016. ISDs were analyzed on the basis of their incidence, patient demographics, seasonal variations, and hospitalization rates.

RESULTS

ISDs were diagnosed in 1680 (67.9%) of the skin consultations (M/F: 1.1; mean age: 4.4 ± 3.7 years). Bacterial infections were observed in 932 (55.5%) cases. Viral infections were seen in 604 patients (35.9%). Fungal and parasite skin infections were diagnosed in 33 (2%) and 111 (6.6%) children, respectively. The most frequent ISDs according to the etiology group were impetigo 377 (22.4%), varicella 397 (23.6%), tinea capitis 10 (0.6%), and scabies 109 (6.5%). A higher frequency of ISDs were reported during the summer (38.4%) and spring (38.2%) months. Bacterial skin infections were more frequent during the summer months, while viral skin infections were more prevalent during spring. Parasitic skin infections were diagnosed more frequently during the winter months. No differences were seen for mycotic skin infections. Hospitalization rate was 1% (all for bacterial skin infections).

CONCLUSION

Our data reveal the extremely high frequency of ISDs seen at the PED, underlying the need for closer cooperation between dermatologists and pediatricians.

Dermatological emergencies: evolution from 2008 to 2014 and perspectives

BACKGROUND

Our dermatological department includes a dermatological emergency unit (DEU) whose activity has grown in recent years.

OBJECTIVES

An audit to characterize the activity of our DEU and its evolution in terms of medical demographics of the area.

METHODS

We collected the following data from administrative services: number of patients consulting each year in the DEU and in the general emergency unit (GEU) of our hospital between 2008 and 2014; daily and seasonal activity of the DEU; occurrence of a second event in the department and proportion of patients from the DEU who were hospitalized and why. From the medical charts of a random sample of patients consulting in the first 15 days of January and August 2014, we studied the epidemiological profile, time to consultation and diagnoses. Data related to medical demographics (number of general practitioners and dermatologists) between 2007 and 2014 and projections were obtained.

RESULTS

The activity in the DEU increased by 67% between 2008 and 2014 but remained stable in the GEU over the same period. The activity was higher on Mondays and in the summer (+30%). More than 15% of the patients were seen a second time in outpatient consultation; 1.2% were hospitalized. Infectious dermatosis was the main reason for consultation; seasonal-disease consultations were more frequent in the summer. Less than 40% of patients consulted in the first week after disease onset. Medical demographics continually decreased since 2007 in Paris and suburbs and will continue to decrease in the next years.

CONCLUSION

The increasing activity of our DEU parallels the decrease in medical demographics in Paris. The proportion of patients hospitalized was low, in part due to specific healthcare networks implemented for some life-threatening dermatoses independent of the DEU. A better coordination between hospital and private practitioners for managing dermatologic emergencies, taking into account the decrease in medical demographics, is warranted.