Inpatient dermatology: Pattern of admissions and patients’ characteristics in an Australian hospital

[Inpatient care for psoriasis: quo vadis?-A retrospective study at the University Hospitals of Aachen, Bonn, and Essen from 2010 to 2019]

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.

Hospital Dermatology: analysis of dermatological consultations in a tertiary teaching hospital

BACKGROUND

In hospital settings, dermatology can offer substantial clinical support for the diagnosis and management of skin conditions, reducing morbidity and mortality. Thus, the study aimed to analyze the profile of referrals and consultations performed by the Dermatology Service of the Santa Casa de Misericordia de Porto Alegre, from August 2018 to January 2020.

METHODS

This study is descriptive, quantitative, and retrospective, conducted through data collection and review of medical records and referrals. The variables included were clinical data of referrals, in-patients profiles, dermatological diagnoses, complementary exams, therapeutic conduct, and recommended follow-ups.

RESULTS

A total of 1020 referrals were analyzed, which resulted in 641 consultations (328 men, 313 women). The most prevalent skin disease groups were 'Dermatitis and Eczema' (33.1%) and 'Other infectious skin diseases (21.8%), while the most frequent ICD-10 were 'Drug eruptions - L27' (9.9%) and 'Other and unspecified dermatitis - L30' (6.6%). Corticoids were the most recommended treatments (27.7%), followed by antifungals (13.1%). 'Consultation Discharge' (44%) and 'Outpatient' Dermatology follow-up (27%) were the most frequent causes for ending consultation.

STUDY LIMITATIONS

Among the study limitations, the authors highlight its retrospective nature, with data analysis based on referrals and medical records, which may present inaccurate or incomplete information. In addition to this, the study may demonstrate a certain degree of subjectivity due to the review and interpretation process conducted by the researchers. However, the definition of objective criteria based on previous studies attenuates such possible bias. Furthermore, considering that the Dermatology teams are composed of a preceptor dermatologist and residents, the established diagnoses were not submitted to third-party verification, except in the cases of skin biopsies and cultures. Thus, the professional's experience and skills may have influenced the dermatological diagnoses.

CONCLUSIONS

These findings underlie the importance of Dermatology in hospital assistance, contributing to the management of a wide range of skin conditions.

Profile of dermatology inpatients and admissions over a four year period in a tertiary level government teaching hospital in North India

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.

An Australian tertiary hospital analysis of outpatient dermatology clinical and demographic characteristics

OBJECTIVES

Literature on dermatology outpatient demographic and clinical data is limited, and the few studies on this topic are mainly conducted overseas, with medical systems and case mix different to Australia. This study presents demographic data relating to dermatology public outpatient referrals to a tertiary hospital in Brisbane, Australia, and determines what additional structured data should be collected to formulate and evaluate initiatives to address service issues such as referral quality, triage process and wait times.

METHODS

A four-year retrospective audit was undertaken, summarising all referrals (n = 7140) and clinical dermatology encounters (n = 53 844) between January 2016 and December 2019 at Princess Alexandra Hospital (PAH), the largest hospital in Metro South Health (MSH), serving a population of one million. PAH has one of the two largest public dermatology clinics in Queensland and is the only dermatology service within MSH.

RESULTS

Patient demographic data, wait time by triage category, referral rates over time and encounter durations were collected. Structured diagnostic data (e.g. ICD-10 coding) of the provisional diagnosis, comorbidities, medications and the final diagnosis are not collected in a structured format and would be a valuable addition.

CONCLUSIONS

The clinical burden of public dermatology is increasing. Both collection and analysis of structured data pertaining to the referrals and encounters are important to help formulate, implement and evaluate initiatives that aim to improve health service provision in this area.

Inpatient dermatology: Where are we headed? A nationwide population-based study of Spain from 2006 to 2016

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.

Five years of dermatological disease requiring specialist care in the Kimberley region of Western Australia

BACKGROUND

Epidemiological studies that document the burden of skin diseases in rural and remote regions of Australia are vital in ensuring proper health-care planning and management. The purpose of this study was to establish the burden of skin disease requiring specialist dermatology input for both the Aboriginal and non-Aboriginal communities in the Kimberley.

METHODS

A retrospective audit of all outpatient encounters with the primary Country Health Service visiting dermatology specialist in the Kimberley region between January 2012 and January 2017.

RESULTS

A total of 2281 encounters were recorded with 1459 unique patients seen. The most common disease categories seen in the general population were premalignant and malignant skin disease (40%), eczema and dermatitis (17%) and benign skin neoplasms (12%). Among Aboriginal patients, the most common conditions were eczema and dermatitis (19%), autoimmune connective tissue disease/rheumatological and autoinflammatory syndromes (17%), adnexal diseases (10%), pigmentary disorders (7%) and benign skin neoplasms (7%).

CONCLUSION

These findings can be used to enhance, direct and plan dermatological services for both the Aboriginal and non-Aboriginal populations in the Kimberley region.

The Role of Oncodermatology in the Care of Patients Receiving Cancer Therapy

OBJECTIVE

To review the emerging sub-specialty of oncodermatology and the role of oncodermatology nurses as facilitators of interprofessional collaboration between the oncology team and the dermatology team.

DATA SOURCES

Journal articles indexed on the National Library of Medicine database.

CONCLUSION

The complexity of cancer care with new cancer therapies and their associated dermatologic adverse events profiles benefit from a collaborative, interprofessional approach between dermatology and oncology in the care of the patient with cancer.

IMPLICATIONS FOR NURSING PRACTICE

Oncodermatology nurses are in roles that can facilitate interprofessional collaboration, optimizing the care of patients with cancer.

Profile of patients admitted to a triage dermatology clinic at a tertiary hospital in São Paulo, Brazil

Background

Knowledge of epidemiological data on skin diseases is important in planning preventive strategies in healthcare services.

Objective

To assess data from patients admitted to a triage dermatology clinic.

Methods

A retrospective study was performed of patients admitted over a one-year period to the Triage Dermatology Clinic at the Hospital das Clínicas of the University of São Paulo Medical School. Data were obtained from record books. The variables analyzed were: patient age, gender, dermatologic disease (initial diagnosis), origin (from where the patient was referred) and destination (where the patient was referred to).

Results

A total of 16,399 patients and 17,454 diseases were identified for analysis. The most frequent skin disorders were eczema (18%), cutaneous infections (13.1%), erythematous squamous diseases (6.8%) and malignant cutaneous neoplasms (6.1%). Atopic dermatitis was the most common disease in children. Acne was more common among children and adults, as were viral warts. Basal cell carcinoma and squamous cell carcinoma were more common in the elderly. Contact dermatitis and acne predominated in women. The most frequent origins were: the primary/secondary health system (26.6%), other outpatient specialties (25.5%), emergency care (14.9%); while the destinations were: discharged (27.5%), follow-up in our Dermatology Division (24.1%), return (14.1%) and the primary/secondary health system (20.7%).

Conclusion

Understanding the incidence of skin diseases is fundamental in making decisions regarding resource allocation for clinical care and research. Thus, we believe our findings can contribute to improving public health policies.

Inpatient Dermatology: Characteristics of Patients and Admissions in a Tertiary Level Hospital in Eastern India

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.

An analysis of inpatient dermatologic consultations at University Hospital Limerick: inadequate infrastructure leads to acute skin failure

BACKGROUND

Approximately 15-20 % of the general population have skin diseases and it is therefore clear that inpatients can also present with various skin conditions that require dermatology input and in some cases the primary reason for admission to hospital. Inpatient hospital care is more expensive than outpatient care. Recent trends are moving towards outpatient care, as there is huge pressure on hospital bed availability.

AIMS

The main aim of this study was to analyse patients referred with dermatological complaints and how soon after admission, were patients assessed by the dermatology team. Most dermatologic work is outpatient based and inpatient workload can be underestimated.

METHODS

We retrospectively reviewed our inpatient consultations with a total of 220 consultations (males 113, females 107) between August 2014 and April 2015, to document this significant area of work over an eight-month period.

RESULTS

The services requesting consultations were mostly general medicine 45.9 % (101/220), surgery 25.4 % (56/220) and paediatrics 24 % (53/220). Dermatologist's diagnosis was different from the referral team diagnosis in 60 % (132/220) of consults, with prompt inpatient assessment by the dermatologist within 24 h of admission. Most common dermatoses diagnosed included eczema 21.8 % (48/220) and psoriasis 7.3 % (16/220).

CONCLUSION

Timely diagnosis and inpatient care has important implications on appropriate treatment, duration of hospital stay and patient outcome.