Report
Experience of a year of adult hospital dermatology consultations Eoin R. Storan1, MB, BCh, BAO, Marian T. McEvoy2, MD, David A. Wetter2, MD, Rokea A. el-Azhary2, MD, PhD, Michael J. Camilleri2,3, MD, Alina G. Bridges2,3, DO, and Mark D. P. Davis2, MD
Departments of 1Internal Medicine, 2 Dermatology, and 3Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA
Abstract
Correspondence Mark D. P. Davis, MD Department of Dermatology Mayo Clinic, 200 First Street SW Rochester, MN 55905, USA E-mail: [email protected]
Objectives We aim to describe the spectrum of skin diseases encountered and the health
Background Dermatology consultations are frequently requested by inpatient hospital services. As inpatient dermatology services in the USA decline, dermatology hospital consultations are becoming increasingly important. care subspecialties requesting dermatology hospital consultations. Methods We performed a retrospective chart review of adult patient (age: ≥18 years) dermatology hospital consultations from January 1 to December 31, 2010. We examined patient demographic characteristics, consultation requesting services, and consultation diagnoses.
Funding: None Conflicts of interest: None
Results Among dermatology services, 614 patients had 674 separate inpatient dermatology consultations during 2010. Of these patients, 55.9% were male (mean age: 59 years). In total, 205 consultations (30.4%) were requested by the internal medicine subspecialty, 137 (20.3%) by the hematology and oncology subspecialty, and 93 (13.8%) by the surgical subspecialty. The most common conditions seen by the hospital dermatology consulting service were skin infections (n = 125, 18.5%), dermatitis (n = 120, 17.8%), drug eruptions (n = 87, 12.9%), chronic wounds and ulcers (n = 55, 8.1%), cutaneous neoplasms (n = 39, 5.8%), graft-versus-host disease (n = 37, 5.5%), ecchymosis, purpura simplex or petechia (n = 26, 3.8%), intertrigo (n = 21, 3.1%), and urticaria (n = 20, 3.0%). Conclusions The majority of consultations conducted by the dermatology hospital consulting service were for the management of common skin diseases, such as cutaneous infections, dermatitis, and drug eruptions. Most consultations were requested by the departments of internal medicine, hematology and oncology, and surgical services.
Introduction
1150
Given the decreasing number of hospitals providing inpatient hospital dermatology services in the USA, the role of inpatient dermatology consulting services has increased in importance. Patients who are primarily admitted with skin disease are increasingly being cared for by a nondermatologist as the primary physician and by a dermatologist in a consulting capacity.1,2 Dermatologists have an important role in caring for hospitalized patients with skin disease. Falanga et al.2 assessed the ability of non-dermatologists in diagnosing various rashes and found the mean diagnostic accuracy of International Journal of Dermatology 2015, 54, 1150–1156
non-dermatologists in diagnosing skin disease to be 48%. They also found that dermatologic consultation resulted in changes in diagnosis and treatment in more than 60% of cases.2 Nahass et al.3 offered skin examinations to all medical patients newly admitted to hospital. They discovered that of 231 patients, 83 (35.9%) had cutaneous findings, and 13.4% of these findings were directly related to systemic disease or the reason for hospitalization. Yet, of these cutaneous findings, the admitting team had identified only 54.0%. The primary care team did not identify all cases of non-melanoma skin cancer and missed certain cases of metastatic cutaneous adenocarcinoma. Dermatology ª 2014 The International Society of Dermatology
Storan et al.
Adult hospital dermatology consultations
Report
consultation facilitated the immediate discharge of certain patients, such as patients with stasis dermatitis admitted for suspected cellulitis. Despite the increasing importance of dermatology hospital consults, the number of dermatologists involved in hospital consultations has declined.4 As a result, there is a risk that skin disease will be overlooked by nondermatologists, and patients may not receive optimal dermatologic care. We describe the activity of the adult dermatology hospital consulting service at our institution and report on the subspecialties requesting dermatology input and on the various skin diseases seen in hospitalized patients.
Table 1 Demographic characteristics of patients seen by the dermatology hospital consulting service during 2010
Materials and methods
SD, standard deviation. a A total of 614 patients had 674 consultations.
Mayo Clinic Institutional Review Board approval was obtained before the present retrospective study was begun. We
Characteristic Sex, n (%) Female Male Race, n (%) American Indian/Alaskan Native Black White Asian Other Unknown/undisclosed Age, years, mean SD (range)
Consultationsa (n = 674)
297 (44.1) 377 (55.9) 6 (0.9) 5 (0.7) 612 (90.8) 3 (0.4) 15 (2.2) 33 (4.9) 58.8 17.4 (18–97)
performed this study of adult (age: ≥18 years) dermatology hospital consultations over one year. Data were extracted from electronic medical records. At our institution, patients whose primary admission diagnosis is skin disease are admitted to the adult dermatology inpatient hospital service. These patients were not included in this study. Pediatric patients (aged
Experience of a year of adult hospital dermatology consultations Eoin R. Storan1, MB, BCh, BAO, Marian T. McEvoy2, MD, David A. Wetter2, MD, Rokea A. el-Azhary2, MD, PhD, Michael J. Camilleri2,3, MD, Alina G. Bridges2,3, DO, and Mark D. P. Davis2, MD
Departments of 1Internal Medicine, 2 Dermatology, and 3Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA
Abstract
Correspondence Mark D. P. Davis, MD Department of Dermatology Mayo Clinic, 200 First Street SW Rochester, MN 55905, USA E-mail: [email protected]
Objectives We aim to describe the spectrum of skin diseases encountered and the health
Background Dermatology consultations are frequently requested by inpatient hospital services. As inpatient dermatology services in the USA decline, dermatology hospital consultations are becoming increasingly important. care subspecialties requesting dermatology hospital consultations. Methods We performed a retrospective chart review of adult patient (age: ≥18 years) dermatology hospital consultations from January 1 to December 31, 2010. We examined patient demographic characteristics, consultation requesting services, and consultation diagnoses.
Funding: None Conflicts of interest: None
Results Among dermatology services, 614 patients had 674 separate inpatient dermatology consultations during 2010. Of these patients, 55.9% were male (mean age: 59 years). In total, 205 consultations (30.4%) were requested by the internal medicine subspecialty, 137 (20.3%) by the hematology and oncology subspecialty, and 93 (13.8%) by the surgical subspecialty. The most common conditions seen by the hospital dermatology consulting service were skin infections (n = 125, 18.5%), dermatitis (n = 120, 17.8%), drug eruptions (n = 87, 12.9%), chronic wounds and ulcers (n = 55, 8.1%), cutaneous neoplasms (n = 39, 5.8%), graft-versus-host disease (n = 37, 5.5%), ecchymosis, purpura simplex or petechia (n = 26, 3.8%), intertrigo (n = 21, 3.1%), and urticaria (n = 20, 3.0%). Conclusions The majority of consultations conducted by the dermatology hospital consulting service were for the management of common skin diseases, such as cutaneous infections, dermatitis, and drug eruptions. Most consultations were requested by the departments of internal medicine, hematology and oncology, and surgical services.
Introduction
1150
Given the decreasing number of hospitals providing inpatient hospital dermatology services in the USA, the role of inpatient dermatology consulting services has increased in importance. Patients who are primarily admitted with skin disease are increasingly being cared for by a nondermatologist as the primary physician and by a dermatologist in a consulting capacity.1,2 Dermatologists have an important role in caring for hospitalized patients with skin disease. Falanga et al.2 assessed the ability of non-dermatologists in diagnosing various rashes and found the mean diagnostic accuracy of International Journal of Dermatology 2015, 54, 1150–1156
non-dermatologists in diagnosing skin disease to be 48%. They also found that dermatologic consultation resulted in changes in diagnosis and treatment in more than 60% of cases.2 Nahass et al.3 offered skin examinations to all medical patients newly admitted to hospital. They discovered that of 231 patients, 83 (35.9%) had cutaneous findings, and 13.4% of these findings were directly related to systemic disease or the reason for hospitalization. Yet, of these cutaneous findings, the admitting team had identified only 54.0%. The primary care team did not identify all cases of non-melanoma skin cancer and missed certain cases of metastatic cutaneous adenocarcinoma. Dermatology ª 2014 The International Society of Dermatology
Storan et al.
Adult hospital dermatology consultations
Report
consultation facilitated the immediate discharge of certain patients, such as patients with stasis dermatitis admitted for suspected cellulitis. Despite the increasing importance of dermatology hospital consults, the number of dermatologists involved in hospital consultations has declined.4 As a result, there is a risk that skin disease will be overlooked by nondermatologists, and patients may not receive optimal dermatologic care. We describe the activity of the adult dermatology hospital consulting service at our institution and report on the subspecialties requesting dermatology input and on the various skin diseases seen in hospitalized patients.
Table 1 Demographic characteristics of patients seen by the dermatology hospital consulting service during 2010
Materials and methods
SD, standard deviation. a A total of 614 patients had 674 consultations.
Mayo Clinic Institutional Review Board approval was obtained before the present retrospective study was begun. We
Characteristic Sex, n (%) Female Male Race, n (%) American Indian/Alaskan Native Black White Asian Other Unknown/undisclosed Age, years, mean SD (range)
Consultationsa (n = 674)
297 (44.1) 377 (55.9) 6 (0.9) 5 (0.7) 612 (90.8) 3 (0.4) 15 (2.2) 33 (4.9) 58.8 17.4 (18–97)
performed this study of adult (age: ≥18 years) dermatology hospital consultations over one year. Data were extracted from electronic medical records. At our institution, patients whose primary admission diagnosis is skin disease are admitted to the adult dermatology inpatient hospital service. These patients were not included in this study. Pediatric patients (aged
