A Retrospective Study to Evaluate the Impact of In-Patient Dermatological Consultations on Diagnostic Accuracy in a Tertiary Care Setting

Abstract

Background: Dermatology is primarily an outpatient specialty. However, dermatology consultations play an important role in care of inpatients. Data on inpatient dermatological consultations in tertiary care settings is limited. Objectives: To evaluate clinical characteristics of inpatient dermatological consultations and effect on clinical outcomes in a tertiary care setting. Methods: This was a single-center retrospective study where the records of all dermatological consultations for patients admitted under various specialties, emergency services, and intensive care units (ICU) at our tertiary care institute over 2 years period were reviewed. The details of patients, primary care unit, dermatological complaints, diagnosis, investigations performed, treatment given, and follow-up were recorded and analyzed. Results: Total of 1717 dermatologic consultations (1000 males) were recorded, with mean age of study population being 33.6 ± 21.6 years (median - 32 years). Out of total 1717 patients, 136 (7.9%), 321 (18.7%), 1135 (66.1%), and 125 (7.3%) patients were infants, children, adolescents, adults, and elderly, respectively. The most frequent diagnostic group was infective diseases (586; 34.1%) followed by inflammatory diseases (442; 25.7%), mucocutaneous adverse drug reactions (160; 9.3%), and autoimmune diseases (65; 3.8%). Primary team's diagnosis was concordant with the dermatology consultation in 1112 (64.8%) patients and discordant observations were recorded in 605 patients (35.2%). Most discordant dermatological diagnoses included inflammatory disorders such as lichen planus, atopic dermatitis, bullous pemphigoid; mechanical disorders; nutritional deficiency disorders, and benign neoplasms. Conclusion: Common skin conditions account for a large majority of dermatologic consultations in a hospital setting. Inpatient dermatology consultations improve the diagnostic accuracy.

The characteristics of dermatology inpatients seen at the quaternary Inkosi Albert Luthuli Central Hospital in Durban, South Africa, over a 5-year period – 2015 - 2020

“…Consultations from neurology, nephrology and rheumatology featured prominently for internal medicine consultations, as in other studies. [16] Similar to findings by Storan et al, [15] the most common cutaneous diseases seen by the hospital dermatology consulting service were skin infections. However, this was noted mostly with surgical specialties.…”

“…The median age of 42 years of patients in the dermatology consultation service is much older than the 32 years observed in a similar study in India. [16] As in other studies, there were more consultations for females than males. [13,14] The most common cause of admission in our dermatology wards was severe, uncontrolled immunobullous disorders, both the pemphigus and pemphigoid groups of diseases.…”

“…The less surgically demanding lesions tend to be referred to dermatology, and vice versa, at our facility. Unlike in other studies, [13,14,16] general internal medicine and general surgery were not the main referring disciplines, as these specialties are not present at our facility.…”

“…[12] Within our hospital, consultations from other departments predominate the inpatient workload for our dermatologists, as observed in other countries. [11] Unlike in other studies, [15,16] the discipline of surgery, mostly through the plastic and reconstructive department, had the greatest need for the dermatology consultation service. This may be explained by common diseases encountered or managed by dermatology and plastic surgery, such as cutaneous malignancies and keloids.…”

Frequency of Skin Diseases in Dermatology Consultations: Descriptive Research

“…The most common diagnoses of skin diseases were infectious diseases, inflammatory diseases, drug reactions and autoimmune diseases. 6 Similarly, a study was conducted in 2021 by Joseph et al to examine skin consultations. In this study, 306 consultations during one year were evaluated.…”