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Poortinga S, Sondermann W, Förster M, Yazdi AS, Bieber T, Balakirski G, Wilsmann-Theis D. [Inpatient care for psoriasis: quo vadis?-A retrospective study at the University Hospitals of Aachen, Bonn, and Essen from 2010 to 2019]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024; 75:170-175. [PMID: 37819277 DOI: 10.1007/s00105-023-05234-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION A number of new, highly effective biologic drugs for psoriasis have been approved over the past few decades, which raises the question whether psoriasis is still a disease that requires inpatient treatment. METHODS We conducted a retrospective analysis of inpatient data between 2010 and 2019 (the last 10 years prior to the coronavirus disease 2019 [COVID-19] pandemic) from three German dermatology departments at university hospitals (Aachen, Bonn, and Essen). The data collected included age, gender, the primary admission diagnosis, length of stay (LOS), and number of all comorbidities recorded during hospitalization. RESULTS A total of 59,500 patients were admitted to the three dermatological departments in the defined 10-year period. Of these patients, psoriasis (L40.-) was the main diagnosis for 4322 (7.3%). An almost continuous increase was observed in all inpatient dermatological cases, which was as high as 27% in 2016 compared to 2010. For psoriasis patients, the most substantial increase in the number of admissions was reached in 2016 compared to 2010 and was as high as 45%. While there was a statistically significant reduction of the mean LOS for all dermatological inpatient cases from 6.4 ± 6.6 days in 2010 to 5.1 ± 4.6 days in 2019 (p < 0.001), the decrease in 2019 compared to 2010 (from 12.2 ± 5.5 to 8.9 ± 3.3 days) was significantly greater for the inpatient psoriasis patients compared to the inpatient population overall (p < 0.001). CONCLUSIONS Our data show a stable need for inpatient psoriasis facilities in Germany. Further analysis of hospital admissions after the end of the COVID-19 pandemic is needed to understand the ongoing influence of modern systemic treatment options on inpatient psoriasis care in Germany.
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Affiliation(s)
- Sietske Poortinga
- Abteilung für Dermatologie, Bergman Clinics, Cromhoffsbleekweg 2, 7513, Enschede, Niederlande.
- Klinik und Poliklinik für Dermatologie und Allergologie, Universitätsklinikum Bonn, Bonn, Deutschland.
| | - Wiebke Sondermann
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - Meike Förster
- Klinik für Dermatologie und Allergologie, Universitätsklinikum der RWTH Aachen, Aachen, Deutschland
| | - Amir S Yazdi
- Klinik für Dermatologie und Allergologie, Universitätsklinikum der RWTH Aachen, Aachen, Deutschland
| | - Thomas Bieber
- Klinik und Poliklinik für Dermatologie und Allergologie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Galina Balakirski
- Klinik und Poliklinik für Dermatologie und Allergologie, Universitätsklinikum Bonn, Bonn, Deutschland
- Zentrum für Dermatologie, Allergologie und Dermatochirurgie, Helios Universitätsklinikum Wuppertal, Universität Witten/Herdecke, Wuppertal, Deutschland
| | - Dagmar Wilsmann-Theis
- Klinik und Poliklinik für Dermatologie und Allergologie, Universitätsklinikum Bonn, Bonn, Deutschland
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Gupta V, Gupta S, Kharghoria G, Pathak M, Sharma VK. Profile of dermatology inpatients and admissions over a four year period in a tertiary level government teaching hospital in North India. Indian J Dermatol Venereol Leprol 2021; 88:342-348. [PMID: 34623048 DOI: 10.25259/ijdvl_711_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/01/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Although dermatology is mostly an outpatient specialty, some patients with severe skin disease need hospital admission for management. There is a paucity of data regarding the profile of these dermatology in-patient admissions. AIMS We studied the profile of patients admitted to the dermatology ward of our tertiary care government hospital in North India. METHODS This was a retrospective analysis of discharge sheets of patients admitted in the dermatology ward from January 1, 2014 to December 31, 2017. RESULTS Discharge sheets of 2032 admissions for 1664 patients were analyzed. The most common diagnoses in the admitted patients were immunobullous disorders (576, 28%), connective tissue diseases (409, 20%), infections, including leprosy and sexually transmitted infections (179, 8.8%), psoriasis (153, 7.5%) and reactive arthritis (92, 4.5%). The mean duration of admission was 13.95±11.67 days (range 1-118 days). Two hundred and fifty-six patients (15.38%) were re-admitted, accounting for 368 (18.11%) re-admissions. Patients with immunobullous disorders (OR 1.72, 95% CI 1.29-2.28) and psoriasis (OR 1.62, 95% CI 1.02-2.55) were more likely to be re-admitted. Adult patients, those who were admitted for more than four weeks, those who had comorbidities, and those who developed a complication during the hospital stay also had a greater likelihood of being re-admitted. LIMITATIONS The retrospective design of the study, and the non-availability of data regarding transfers to other specialties or intensive care units and deaths were the main limitations of this study. CONCLUSION This study describes the profile of patients admitted in a dermatology ward of a tertiary care centre center in North India. The patient profile and admission characteristics associated with a higher probability of re-admission were identified.
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Affiliation(s)
- Vishal Gupta
- Department of Dermatology and Venereology, New Delhi, India
| | - Savera Gupta
- Department of Dermatology and Venereology, New Delhi, India
| | | | - Mona Pathak
- Biostatistics, All India Institute of Medical Sciences, New Delhi, India
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Cuenca-Barrales C, de Vega-Martínez M, Descalzo-Gallego MÁ, García-Doval I. Stationäre Dermatologie: Wohin geht die Reise? Eine landesweite bevölkerungsbasierte Studie in Spanien von 2006 bis 2016. J Dtsch Dermatol Ges 2021; 19:707-719. [PMID: 33979051 DOI: 10.1111/ddg.14336_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 11/04/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Carlos Cuenca-Barrales
- Research Unit, Fundación Piel Sana Academia Española de Dermatología y Venereología, Madrid, Spain
| | - Marina de Vega-Martínez
- Research Unit, Fundación Piel Sana Academia Española de Dermatología y Venereología, Madrid, Spain
| | | | - Ignacio García-Doval
- Research Unit, Fundación Piel Sana Academia Española de Dermatología y Venereología, Madrid, Spain.,Dermatology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
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Cuenca-Barrales C, de Vega-Martínez M, Descalzo-Gallego MÁ, García-Doval I. Inpatient dermatology: Where are we headed? A nationwide population-based study of Spain from 2006 to 2016. J Dtsch Dermatol Ges 2021; 19:707-717. [PMID: 33617112 DOI: 10.1111/ddg.14336] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 11/04/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Information about hospital admissions for skin diseases is restricted to studies describing admissions to single centers, to specific wards, or only for a few diagnoses, and there is no information about the outcomes between different wards. The aim of this research is to describe hospital admissions due to dermatological diseases. PATIENTS AND METHODS Cross-sectional study of hospital discharges at Spanish hospitals. Discharges were assumed to be the same as admissions. RESULTS 519,440 discharges (1.1 % of total discharges) were identified. Most admissions (60.1 %) were done from emergency departments. Only 7 % of cases were admitted to dermatology wards. The most prevalent group was cellulitis and acute lymphangitis. Median age was 57 years, and men were more common. The median length of hospital stay was four days; 40,823 (7.9 %) cases required readmission. There were 13,558 (2.6 %) hospital deaths. After adjusted analysis (by age, sex and group of diagnosis), the OR of readmission was 1.49 (95 % CI: 1.42-1.57) times higher and length of stay was 0.22 (95 % CI: 0.15-0.29) days longer in non-dermatology wards (P < 0.0001). From 2006-2016, admissions to dermatology wards decreased 38 %, while in non-dermatology wards they increased 8 %. CONCLUSIONS A non-negligible number of patients require dermatological inpatient management. This is mainly provided by non-dermatologists. Some of our findings may indicate an improved overall care by dermatologists.
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Affiliation(s)
- Carlos Cuenca-Barrales
- Research Unit, Fundación Piel Sana Academia Española de Dermatología y Venereología, Madrid, Spain
| | - Marina de Vega-Martínez
- Research Unit, Fundación Piel Sana Academia Española de Dermatología y Venereología, Madrid, Spain
| | | | - Ignacio García-Doval
- Research Unit, Fundación Piel Sana Academia Española de Dermatología y Venereología, Madrid, Spain.,Dermatology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
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Sen A, Chowdhury S, Poddar I, Bandyopadhyay D. Inpatient Dermatology: Characteristics of Patients and Admissions in a Tertiary Level Hospital in Eastern India. Indian J Dermatol 2016; 61:561-4. [PMID: 27688450 PMCID: PMC5029246 DOI: 10.4103/0019-5154.190104] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction: Dermatology is primarily a non-acute, outpatient-centered clinical specialty, but substantial number of patients need indoor admission for adequate management. Over the years, the need for inpatient facilities in Dermatology has grown manifold; however, these facilities are available only in some tertiary centers. Aims and Objectives: To analyze the characteristics of the diseases and outcomes of patients admitted in the dermatology inpatient Department of a tertiary care facility in eastern India. Materials and Methods: We undertook a retrospective analysis of the admission and discharge records of all patients, collected from the medical records department, admitted to our indoor facility from 2011 to 2014. The data thus obtained was statistically analyzed with special emphasis on the patient's demographic profile, clinical diagnosis, final outcome, and duration of stay. Results and Analysis: A total of 375 patients were admitted to our indoor facility during the period. Males outnumbered females, with the median age in the 5th decade. Immunobullous disorders (91 patients, 24.27%) were the most frequent reason for admissions, followed by various causes of erythroderma (80 patients, 21.33%) and infective disorders (73 patients, 19.47%). Other notable causes included cutaneous adverse drug reactions, psoriasis, vasculitis, and connective tissue diseases. The mean duration of hospital stay was 22.2±15.7 days; ranging from 1 to 164 days. Majority of patients (312, 83.2%) improved after hospitalization; while 29 (7.73%) patients died from their illness. About 133 patients (35.64%) required referral services during their stay, while 8 patients (2.13%) were transferred to other departments for suitable management. Conclusion: Many dermatoses require inpatient care for their optimum management. Dermatology inpatient services should be expanded in India to cater for the large number of cases with potentially highly severe dermatoses.
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Affiliation(s)
- Arpita Sen
- Department of Dermatology, Venereology and Leprosy, Medical College and Hospital, Kolkata, West Bengal, India
| | - Satyendranath Chowdhury
- Department of Dermatology, Venereology and Leprosy, Medical College and Hospital, Kolkata, West Bengal, India
| | - Indrasish Poddar
- Department of Dermatology, Venereology and Leprosy, Medical College and Hospital, Kolkata, West Bengal, India
| | - Debabrata Bandyopadhyay
- Department of Dermatology, Venereology and Leprosy, Medical College and Hospital, Kolkata, West Bengal, India
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Bale J, Chee P. Inpatient dermatology: Pattern of admissions and patients’ characteristics in an Australian hospital. Australas J Dermatol 2013; 55:191-5. [DOI: 10.1111/ajd.12097] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 05/01/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Jessica Bale
- Department of Medicine; John Hunter Hospital; Newcastle New South Wales Australia
| | - Paul Chee
- Department of Dermatology; John Hunter Hospital; Newcastle New South Wales Australia
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de Paula Samorano-Lima L, Quitério LM, Sanches JA, Neto CF. Inpatient dermatology: profile of patients and characteristics of admissions to a tertiary dermatology inpatient unit in São Paulo, Brazil. Int J Dermatol 2013; 53:685-91. [PMID: 23675752 DOI: 10.1111/j.1365-4632.2012.05818.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Dermatology is primarily an outpatient clinical and surgical specialty, but substantial numbers of patients are admitted to hospital for inpatient treatment in dermatology wards. METHODS We performed a retrospective study of patients admitted to dermatology beds between September 1, 2002, and September 30, 2010. Patient data were analyzed for age, gender, ethnicity, length of stay (LoS), dermatologic disease, comorbidities, hospital-acquired infection (HAI), transfer to the intensive care unit (ICU), and mortality. RESULTS A total of 3308 patients admitted during this 8-year period were identified for analysis. The most frequent admissions were for eczema/dermatitis (17.5%) and cutaneous infections (15.9%). The mean LoS was 13.0 days. The mean ± standard deviation (SD) number of comorbidities per patient was 1.0 ± 1.2, among the most frequent of which were hypertension and diabetes mellitus. The rate of HAI was 6.2%; bloodstream infection was regarded as the most commonly acquired type and Staphylococcus aureus as the infectious agent most commonly found in culture. Of the patients admitted, 3.7% were transferred to the ICU and 2.5% died. In these latter two groups, the most common dermatologic diagnoses were immunobullous diseases, and the mean hospital LoS and rate of HAI were higher than in the total admissions cohort. CONCLUSIONS Higher value should be placed on dermatology inpatient services in order to expand the availability of dermatology beds, mainly in tertiary hospitals, in view of the potentially high severity of the dermatologic diseases found in many patients referred to this type of service.
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Storan E, McEvoy M, Wetter D, el-Azhary R, Bridges A, Camilleri M, Davis M. Experience with the dermatology inpatient hospital service for adults: Mayo Clinic, 2000-2010. J Eur Acad Dermatol Venereol 2012; 27:1360-5. [DOI: 10.1111/jdv.12010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bos J, Schram M, Mekkes J. Dermatologists are Essential for Quality of Care in the General Practice of Medicine. ACTAS DERMO-SIFILIOGRAFICAS 2009; 100 Suppl 1:101-5. [DOI: 10.1016/s0001-7310(09)73174-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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García-Diez A, Ferrandiz Foraster C, Vanaclocha Sebastián F, Lizán Tudela L, Badia Llach X, Sellers Fernández G. What Characterizes the Severity of Psoriasis? Dermatology 2008; 216:137-51. [DOI: 10.1159/000111511] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2007] [Accepted: 06/28/2007] [Indexed: 12/20/2022] Open
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Woods A, Rutter K, Gardner L, Lewis V, Saxena S, George S, Chalmers R, Griffiths C, Speight E, Anstey A, Ronda L, McGibbon D, Barker J, Smith C. Inpatient management of psoriasis: a multicentre service review to establish national admission standards. Br J Dermatol 2007; 158:266-72. [DOI: 10.1111/j.1365-2133.2007.08338.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ayyalaraju RS, Finlay AY, Dykes PJ, Trent JT, Kirsner RS, Kerdel FA. Hospitalization for severe skin disease improves quality of life in the United Kingdom and the United States: a comparative study. J Am Acad Dermatol 2003; 49:249-54. [PMID: 12894073 DOI: 10.1067/s0190-9622(03)00897-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Financial and managerial constraints have resulted in the rationalization of dermatology inpatient services in the United Kingdom and the United States. Therapeutic regimes may vary locally, regionally, and internationally but the clinical outcome of treatment remains the same. OBJECTIVE We studied 2 inpatient units: the University of Wales College of Medicine, Cardiff, United Kingdom, and the University of Miami School of Medicine, Miami, Florida, to compare the use and effectiveness of the service provided. METHODS Data were collected prospectively from inpatients during a 12-month period. The Dermatology Life Quality Index was administered on admission and after discharge. Data were recorded about the diagnosis, duration of admission, and referring dermatologist. RESULTS In all, 295 patients (Cardiff, UK) and 366 patients (Miami, Fla) participated. The average duration of admission in Miami was 6.7 days compared with 14.2 (P <.0001) in Cardiff. In Miami, the most common reasons necessitating admission were extensive disease (54%), the patient being unwell (18%), photophoresis (14%), outpatient treatment failure (8%), and acute deterioration of disease (4%). In Cardiff, the common reasons were acute deterioration (35%), extensive disease (28%), outpatient treatment failure (22%), and liver biopsy (4%). The most common diagnoses in Cardiff were psoriasis (31%) and eczema (26%). In contrast, the most common diagnoses in Miami, were psoriasis (19%), leg ulcers (17%), and mycosis fungoides (14%). The mean Dermatology Life Quality Index value for all patients decreased after admission in Cardiff (14.9-8.2, P <.0001) and Miami (12.0-8.5, P <.0001). CONCLUSION Despite the differences in the 2 health care systems, inpatient therapy remains an important and effective therapeutic option in the United States and the United Kingdom.
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Affiliation(s)
- R Sowjanya Ayyalaraju
- Department of Dermatology at University of Wales College of Medicine, Heath Park, United Kingdom
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