Children with dermatological conditions admitted to paediatric intensive care: analysis of a national clinical audit database

Mucocutaneous findings among children in the pediatric intensive care unit at a tertiary care center: A prospective observational study from South India

BACKGROUND/OBJECTIVES

Children admitted to a pediatric intensive care unit (PICU) can present with a variety of skin lesions and the need for dermatology consultation is increasing. Dermatoses in the PICU can be primary or secondary to treatment or underlying systemic illness. Our objective was to study the frequency, pattern, and systemic associations of mucocutaneous findings among children in the PICU.

METHODS

We conducted a prospective, observational study in the PICU of our hospital for 1 year from January 2019 to December 2019. Detailed history, examination, and treatment of consecutive children admitted with mucocutaneous findings were recorded and the results were tabulated and analyzed.

RESULTS

Among 2606 children screened, 11.5% (300/2606) had 314 mucocutaneous manifestations. The male-to-female ratio was 1.3:1 and their ages ranged from 1 month to 15 years (mean age, 4.4 years). Dermatoses belonged to infectious, 41% (124/314), inflammatory, 29.6% (93/314), nutritional, 12.4% (39/314), hematological/vascular malformations, 3.5% (11/314), rheumatological/vasculitic, 3.2% (10/314), neurocutaneous, 0.6% (2/314), and miscellaneous, 11.1% (35/314) groups. Within this cohort, 25.7% (77/300) had a purely dermatological disorder, 28.3% (85/300) had an associated systemic process, 0.7% (2/300) had iatrogenic skin findings, and 45.3% (136/300) had incidental skin findings. On follow-up, 4% (12/300) died, 85% (256/300) improved/recovered, 3% (8/300) were lost to follow-up, and 8% (24/300) did not need active intervention.

CONCLUSION

Our study highlights the frequency of dermatologic disorders among children in the PICU. A notable proportion of patients had primary dermatological disorders or mucocutaneous findings associated with systemic illness.

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.

Necrotizing fasciitis after scrotum skin injury in an infant: A case report

RATIONALE

Necrotizing fasciitis (NF) is a life-threatening situation that is rare in children, especially infants, and early diagnosis is challenging. Timely identification and broad-spectrum antibiotic and supportive treatment before surgical debridement are very important for survival and may reduce scar formation.

PATIENT CONCERNS

A previously healthy 4-month-old infant was admitted to our pediatric intensive care unit (PICU) with a history of fever and cough for 5 days and extreme swelling of the scrotum for one day. Necrotic-like tissue without margins appeared on his scrotum and perineum in 24 hours.

DIAGNOSIS

NF was suspected, and the patient soon developed shock. The patient underwent surgical debridement after his condition stabilized. Pathological analysis confirmed the diagnosis of NF.

INTERVENTION

Broad-spectrum antibiotic, immediate fluid resuscitation, assistant ventilation, and vasoactive drugs were administered. Surgical debridement and autologous split-thickness skin grafting were performed.

OUTCOMES

The wound recovered well after 2 months. Ultrasound revealed normal testicles, and no anorectal injury was found.

LESSONS

Close clinical monitoring and timely treatment of skin injuries in sick children are very important. Sufficient antibiotic administration and supportive treatment before surgical debridement are crucial for survival from NF.