Inpatient Dermatology Consultation Research Articles

Pediatric Dermatology Clinical-Pathologic Cases: A Spectrum of Purpuric Disorders of Childhood

In the following sections, we will present three recent cases of pediatric purpura encountered on the inpatient dermatology consult service from a tertiary pediatric hospital. In all cases, the final diagnoses were established with dermatopathologic-clinical correlation and special stains.

The Reliability of Teledermatology to Triage Inpatient Dermatology Consultations

Many hospitals do not have inpatient dermatologic consultative services, and most have reduced availability of services during off-hours. Dermatologists based in outpatient settings can find it challenging to determine the urgency with which they need to evaluate inpatients when consultations are requested. Teledermatology may provide a valuable mechanism for dermatologists to triage inpatient consultations and increase efficiency, thereby expanding access to specialized care for hospitalized patients. To evaluate whether a store-and-forward teledermatology system is reliable for the initial triage of inpatient dermatology consultations. Prospective study of 50 consenting adult patients, hospitalized for any indication, for whom an inpatient dermatology consultation was requested between September 1, 2012, and April 31, 2013, at the Hospital of the University of Pennsylvania, an academic medical center. The participants were evaluated separately by both an in-person dermatologist and 2 independent teledermatologists. The primary study outcomes were the initial triage and decision to biopsy concordance between in-person and teledermatology evaluations. Triage decisions were as follows: if the in-person dermatologist recommended the patient be seen the same day, the teledermatologist agreed in 90% of the consultations. If the in-person dermatologist recommended a biopsy, the teledermatologist agreed in 95% of cases on average. When the teledermatologist did not choose the same course of action, there was substantial diagnostic agreement between the teledermatologist and the in-person dermatologist. The Kendall τ rank correlation coefficients for initial triage concordance between the in-person dermatologist and teledermatologists were 0.41 and 0.48. The Cohen κ coefficients for decision to biopsy concordance were 0.35 and 0.61. The teledermatologists were able to triage 60% of consultations to be seen the next day or later. The teledermatologists were able to triage, on average, 10% of patients to be seen as outpatients after discharge. Teledermatology is reliable for the triage of inpatient dermatology consultations and has the potential to improve efficiency.

Antibiotic Sensitivity and Resistance Patterns in Pediatric Staphylococcal Scalded Skin Syndrome

Historical resistance patterns often guide empiric antibiotic choices in staphylococcal scalded skin syndrome (SSSS), but little is known about the difference in susceptibility between SSSS and other childhood staphylococcal infections. A retrospective chart review of culture-confirmed cases of SSSS seen in the inpatient dermatology consultation service at the Children's Hospital of Philadelphia between 2005 and 2011 was performed. Most cases of SSSS at our institution are due to oxacillin-susceptible Staphylococcus aureus, and approximately half of the cases are due to clindamycin-resistant strains. Clindamycin and a penicillinase-resistant penicillin are suggested as empiric treatment for SSSS until culture susceptibility data are available to guide therapy.

Inpatient Dermatology Consultation in a Spanish Tertiary Care Hospital: A Prospective Cohort Study

Background and objectiveAlthough dermatology has traditionally been practiced through outpatient consultation, hospitalized patients often have dermatologic problems. The aim of this study was to describe and quantify the volume of interdepartmental consultation of the dermatology department of Hospital Universitario Virgen del Rocío. Material and methodsIn this year-long prospective observational cohort study of 429 patients we used a specific data collection form to record information on consultations for patients admitted between July 2010 and June 2011. ResultsThe 429 consultations over the 12 months of study accounted for 1.56% of all first consultations with a dermatologist during the period. A mean of 1.75 new patients were attended each day. The mean (SD) age of the patients was 52.63 (19) years, and the ratio of men to women was 1.21. Immunocompromised patients accounted for more than a third of the cohort. The medical specialties consulting most often were internal medicine (n=115) and hematology (n=66). The most frequent diagnoses were inflammatory skin conditions (36.2%) and infectious skin diseases (26.5%). Discussion and conclusionsTo date, the role of interdepartmental consultation in dermatology has been little studied. Our results suggest that dermatology plays a fundamental role within the hospital. We have identified the most common skin problems in hospitalized patients and their clinical course.

Ethical issues in inpatient consultative dermatology

Ethical issues commonly arise in inpatient dermatology consultations. We describe the case of an inpatient suffering from a severe, undiagnosable skin condition that raises key principles of medical ethics. The four principles include autonomy, nonmaleficence, beneficence, and justice. Ethical situations faced by inpatient dermatologists are similar to those experienced by medicine hospitalists, as compared with outpatient dermatologists, given the unique clinical setting in which inpatient dermatology is practiced. Other inpatient services, colleagues, and ethics committees are useful resources for inpatient dermatologists faced with difficult ethical situations.

Dermatology referrals in an East Asian tertiary hospital: a need for inpatient medical dermatology

Within hospitals, there is a need for dermatological expertise, as hospitalized patients have a wider spectrum of severe and serious dermatological conditions, associated with significant morbidity. To characterize the patient profile and referral pattern of inpatient dermatology consultations, and to evaluate the diagnostic accuracy of non-dermatologists. This was a retrospective study reviewing all inpatient referrals for dermatology consultations during a 1-year period from July 2005 to June 2006 (inclusive), at the largest multi-disciplinary tertiary hospital in Singapore. Of the 731 referrals made for dermatology consultations, 26.9% of patients had ≥ 3 important underlying comorbidities. Eczema/dermatitis (33.1%; n = 242) and cutaneous infections (23.4%; n = 171) accounted for over half of the dermatological consultations, followed by cutaneous adverse drug reactions (12.3%; n = 90). The provisional diagnoses of the referring doctors agreed with the final diagnoses confirmed by dermatologists in only 30.2% of all referrals; incorrect diagnoses were made in 35.2% of cases, and no provisional diagnoses were made in the remaining 34.6% of cases. Most misdiagnosed skin diseases were in fact common dermatoses (such as eczemas, cutaneous infections, drug rash) that required only standard treatment. Our study reiterates the importance of inpatient medical dermatology in terms of both service and education. There should be continual efforts to ensure that dermatologists have the highest level of training and experience in medical dermatology, to provide collaborative optimum care for hospitalized patients with dermatological diseases.

Dermatology inpatient consultations: A retrospective study

Dermatology inpatient consultations: A retrospective study

Inpatient dermatological consultations in a university hospital

INTRODUCTION:Dermatology is primarily an outpatient specialty, but it also plays an important role in the care of inpatients.METHODS:We conducted a prospective study that recorded data from inpatient dermatology consultation request forms over a period of four months. The study evaluated 313 requests that led to 566 visits, 86 biopsies, 35 laboratory exams, 41 direct microscopic studies, 18 direct immunofluorescence analyses, 14 skin cultures and a few other exams.RESULTS:The most frequent requesting service was internal medicine (24%), followed by neurology (12%), cardiology (11%), infectious diseases and pediatrics (8% each) and psychiatry and general surgery (6% each). The most frequent diagnostic groups were infectious diseases (25%, divided into fungal infections (13%), bacterial infections (7%) and viral infections (5%)), eczemas (15%) and drug reactions (14%). To our knowledge, this is the first study to attempt to evaluate the impact of the consultations by asking multiple‐choice questions that were analyzed by the authors. In 31% of the cases, the consultation was considered extremely relevant because it aided in managing the disease that led to admission or treated a potentially severe dermatological disease. In 58% of the cases, the consultation was considered important because it facilitated diagnosis and/or treatment of a dermatological disease that was unrelated to the reason for admission.

INPATIENT DERMATOLOGY CONSULTATION

Common dermatologic conditions and skin signs of systemic disease are routinely present in hospitalized patients. Rapid detection and identification of these changes can have a significant impact on the patient's hospital course. Inpatient dermatology consultation can improve diagnostic accuracy, efficiency, and treatment of hospitalized patients with cutaneous findings. This article discusses the clinical aspects of inpatient dermatology consultation and the features of effective consultation.

HIV AND AIDS IN INPATIENT DERMATOLOGY: Approach to the Consultation

In the inpatient setting, the dermatologic consultant is called on to address the whole spectrum of cutaneous disease seen in HIV/AIDS patients, with severity varying from severe life-threatening to less serious conditions that dramatically affect quality of life. Rather than reviewing a "laundry list" of conditions associated with HIV/AIDS or the most severe conditions, this article aims to demonstrate a systematic approach to inpatient dermatology consultation in HIV/AIDS patients and to briefly review several common and interesting topics frequently addressed in the inpatient setting (e.g., medications issues, and phototherapy in HIV-infected patients).

Inpatient Dermatology Consultations at a Medical Center

To the Editor.— In recent years, there have been several articles in the literature on instructional priorities in dermatology for medical students and physicians in training for primary care careers. 1-3 It has also been observed that the majority of dermatologic complaints are directed to nondermatologists 4 and that primary care physicians may lack the ability to recognize common dermatoses. 5 The dermatology division within the department of medicine was established at the University of Florida, Gainesville, in July 1982, with the appointment of two full-time faculty members. The inpatient consultations at the Shands Teaching Hospital, Gainesville, and the Gainesville Veterans Administration Medical Center during the first year are summarized in the Table. It is notable that approximately 57% of the inpatient dermatologic diagnoses were those of common dermatoses often seen in primary care settings. 4 These same dermatoses may be poorly recognized by primary care physicians. 5 It is

Inpatient dermatology consultations at a medical center

Inpatient dermatology consultations at a medical center