Bilan d’activité d’une consultation post-urgence rapide pour la prise en charge des urgences dermatologiques

Abstract

Dermatological emergencies generally consist of infection and inflammation, including cutaneous drug reactions. Most patients are either not seen again or else are followed by their GP, but it may be a long time before they see a dermatologist once more, even if monitoring is necessary. We created a rapid post-emergency consultation reserved for these patients alone requiring short-term reevaluation, and we report the results of the new consultation herein. One consultation per week is exclusively for patients seen in dermatological emergency units requiring rapid reassessment (i.e. within two weeks) for follow-up or in cases of uncertainty in the diagnosis. Between June 2008 and June 2009, 40 consultations were carried out, with 370 patients being enrolled and 214 attending the consultation (40% absenteeism), i.e. 3% of emergency unit patients. The mean time from the emergency consultation was 9.2 days and the reasons for consultation were: 34% infectious dermatoses, 36% inflammatory dermatoses, 7.5% cutaneous drug reactions and 19% miscellaneous diagnosis, with 4.2% uncertainty about diagnosis. The outcome after the emergency consultation was favourable in 76% of cases (complete healing or improvement). A follow-up consultation was proposed in 41.5% of cases, with 77.5% of patients attending. While the creation of this consultation did not significantly reduce the number of patients returning to the emergency service, it was welcomed by all dermatologists in charge of such dermatological emergency services. This rapid post-emergency consultation forms a small part of the activities of the dermatological emergency unit but is positive in the view of the dermatologists in charge of emergency consultations since it means patients can be given appointments soon after initial treatment, thus avoiding the need to return to the emergency unit. The diseases seen at this unit are similar to those seen in the emergency unit. While absenteeism is considerable, this type of consultation results in the organisation of further ongoing care for 40% of patients, most of whom comply with treatment.