Hospital triage and skin disease: hospital outcomes are differentially associated with cutaneous morphology.

Abstract

Determining the exact dermatologic diagnosis is difficult in the inpatient setting. Determine whether morphologic classification rather than specific diagnosis is associated with hospital outcomes. Retrospective single-center study. Information from 1798 inpatient dermatology consults at The Ohio State University Wexner Medical Center from 2012 to 2014 was queried. Dermatologic diseases were categorized into 16 groups based on appearance. Logistic regression was performed comparing mortality rate vs morphology. Linear regression was performed comparing the length of stay (LOS) vs morphology. Morphology was associated with a mortality rate (P=0.038). The morphologic subgroups acneiform/follicular/occlusion (P=0.011), blistering disorders (P=0.009), retiform purpura (P=0.011), and vasculitis/vascular (P=0.007) were associated with increased mortality. Morphology was associated with LOS (P=0.004), and the morbilliform subgroup was associated with increased LOS (P < 0.001). This study demonstrated the importance of morphologic diagnosis and its association with mortality rate and LOS. This information may help triage cutaneous disorders in the inpatient setting and determine the relative risk of dermatologic conditions when assessing the need for hospital transfers and more aggressive therapies.