NEW YORK (Reuters Health) – Inpatient dermatology consultations for skin disorders are associated with improved diagnostic accuracy and faster intervention, researchers have
Information about the impact of hospitalist dermatology consultative services is limited, Dr. Daniela Kroshinsky from Massachusetts General Hospital in Boston and colleagues note in JAMA Dermatology, online January 13.
To learn more, the team conducted a cross-sectional study of data from dermatology consult teams at four academic medical centers in the U.S. Full-time inpatient dermatologists with resident teams performed a total of 1,661 inpatient dermatology consultations within 24 to 48 hours of request over 12 months from 2008 to 2009.
All final diagnoses were based on clinical history, examination findings, and laboratory testing. Each service (primary team) that asked for a dermatology consult provided its presumptive diagnosis at the time of its request.
The most common primary teams were Medicine (47%), followed by Surgery (15%), Intensive Care Units (12%), and Hematology-Oncology (9%). The most commonly undiagnosed or misdiagnosed conditions by the primary teams were cellulitis, leg ulcerations, and viral infections. The majority of primary team preliminary diagnoses included rash/unknown (n=814), followed by cellulitis/abscess (n=115), and drug rash (n=111). The majority of primary diagnoses by dermatologists included drug rash (n=292; 18%), psoriasis/eczema (n=170; 10%), and benign neoplasm (n=168; 10%).
The dermatologists identified additional cutaneous issues in 298 (18%) of consults; diagnosis was confirmed by biopsy in 667 (40%) patients. Overall, dermatology consultation changed the final diagnosis in 71% of consultation requests.
Just under a third of the patients were admitted to the hospitals because of their skin conditions. In the remaining cases, the dermatologic issues were found incidentally or developed during hospitalization.
In 40% of cases, dermatology-specific evaluation and treatment recommendations were carried out in a single visit; 29% required one follow-up evaluation and 16% required two.
“This is the first multicenter national study to define the nature of dermatologic issues presenting to academic medical centers and to demonstrate the impact dermatologists have on improving the correct diagnosis of patients with skin issues,”Dr. Kroshinsky told Reuters Health by email.
Hospitalist dermatology is an important and effective subset of dermatology and hospital medicine, she said.
“Ideally,” Dr. Kroshinsky added, “hospitals would have access to a dermatologist in real-time or via teledermatology.”