Exanthems in Hospitalized Pediatric Patients: Concordance between Pediatric and Dermatological Diagnoses

Abstract

Background: Exanthems in children often represent a diagnostic challenge. Purpose: To determine the concordance between pediatric and dermatological diagnoses of exanthems. Design: Prospective study. Procedure: Exanthems that appeared in hospitalized pediatric patients were diagnosed by pediatricians. Pediatric dermatologists, by consensus, either confirmed or modified the diagnoses. Whenever possible, laboratory tests were used to confirm the final clinical diagnoses. Age and evolution were compared with the Kruskal-Wallis test; the ĸ coefficient was used to determine concordance. Setting: Institutional tertiary referral pediatric care center. Results: Concordance between pediatric and dermatological diagnoses was found in only 44 patients. When pediatric and dermatological diagnoses of exanthems were classified, the concordance between both diagnoses was very low (ĸ = 0.165). Conclusions: Pediatric specialists, other than dermatologists, failed to diagnose common skin diseases. This may be a consequence of insufficient training in dermatology by medical schools and pediatric residency.

Pediatric Dermatology: Past, Present, and Future

“…Data collected from the National Institute of Pediatrics in Mexico City between 1995 and 1999 compared diagnoses made by pediatric and dermatology residents for more than 200 skin findings and found that pediatric residents misdiagnosed more than 75% of cases. This inadequacy was attributed to a lack of dermatology exposure during training in Mexico, where an average of 0.8% of the medical student curriculum was allocated to dermatology, and similar to training in the United States, where a rotation in dermatology was optional for pediatric residents, despite a much greater prevalence of skin complaints in Mexico .…”

“…Ideally, primary care physicians should be able to treat a significant number of these children, but the proportion of pediatric residency training dedicated to learning about the diagnosis and management of dermatologic disease does not reflect disease prevalence. Pediatric residents' and practicing pediatricians' diagnostic errors have been reported to range from 80% to 90% . The true number of incorrect diagnoses may be lower, but each incorrect diagnosis can lead to inappropriate testing and management, which can result in poorer patient outcomes and higher medical costs.…”

Paediatric Skin Disorders Encountered in an Emergency Hospital Facility: A Prospective Study

“…In the study by Dolan et al, the diagnostic agreement between junior doctors and dermatologists in an open-access dermatology clinic was 66% (2). Soriano-Hernandez et al (11) reported very poor agreement (20% of diagnoses) between paediatricians and dermatologists in Mexico City, for exanthemas in hospitalized paediatric patients. In our study, diagnostic agreement could not be studied in the entire PECU population because a DOC visit did not always occur immediately after the PECU visit.…”

The Spectrum of Skin Disease Among Indian Children

“…Our results are different from others (41,42), where the most common referrals were from internal medicine, primarily because both adults and children were included in these studies. Of interest in these studies (41,42) like others (14,43), pediatricians also constituted a significant referral base to dermatology clinics. These figures reflect the high frequency with which skin ailments occur in pediatric medicine and the obvious need for education in pediatric dermatology (44).…”