Hon Kam Lun, Leung Ting Fan, Wong Yin, Ma Kwok Chiu, Fok Tai Fai
Department of Pediatrics, Chinese University of Hong Kong, 6/F Clinical Sciences Building, Prince of Wales Hospital, Shatin, Hong Kong, ROC.
Pediatr Dermatol. 2004 Mar-Apr;21(2):109-12. doi: 10.1111/j.0736-8046.2004.21203.x.
Understanding the pattern of disease referrals is important in the delivery of a service. We followed 331 new referrals at a pediatric dermatology clinic over 12 months. Fifty percent of the patients were female; 293 patients (88.5%) had a single diagnosis and 36 (10.9%) had two diagnoses. Three leading causes for referrals accounted for 60% of the 371 skin diseases encountered: 124 diagnoses (33%) were of eczema, 73 diagnoses (20%) were of nevi, and 22 diagnoses (6%) were of viral warts. The nevi seen included melanocytic, epidermal, sebaceous, and vascular nevi. Skin biopsies were performed in 23 patients (6.9%), and microscopy and culture for fungal infections in 11 patients (3.3%). Forty-one patients (12%) were referred to the laser clinic for assessment of their nevi or pigmented skin lesions. Topical steroids were prescribed in 47% of patients during their follow-ups. Follow-up appointments were offered to 90% of patients. Eczema required the most frequent follow-up. Gender disparity in referrals was evident only in endogenous eczema (odds ratio [OR] 1.64, 95% confidence interval [CI] 1.04-2.60 in males; p = 0.033). Girls were more likely to be referred to the laser clinic than boys (OR 2.31, 95% CI 1.10-4.92; p = 0.026). Most dermatologic diagnoses were made on clinical grounds and moderately potent topical corticosteroids were the most commonly prescribed medication. Since chronic skin disorders prevailed in the referrals, repeated follow-up appointments were required.
了解疾病转诊模式对于提供医疗服务很重要。我们在12个月内跟踪了一家儿科皮肤科诊所的331例新转诊病例。50%的患者为女性;293例患者(88.5%)有单一诊断,36例(10.9%)有两种诊断。转诊的三大主要原因占所遇到的371种皮肤病的60%:124例诊断(33%)为湿疹,73例诊断(20%)为痣,22例诊断(6%)为病毒疣。所见的痣包括黑素细胞痣、表皮痣、皮脂腺痣和血管痣。23例患者(6.9%)进行了皮肤活检,11例患者(3.3%)进行了真菌感染的显微镜检查和培养。41例患者(12%)被转诊至激光诊所评估其痣或色素沉着性皮肤病变。47%的患者在随访期间开具了外用类固醇药物。90%的患者获得了随访预约。湿疹需要最频繁的随访。转诊中的性别差异仅在内源性湿疹中明显(男性的优势比[OR]为1.64,95%置信区间[CI]为1.04 - 至2.60;p = 0.033)。女孩比男孩更有可能被转诊至激光诊所(OR 2.31,95% CI 1.10 - 4.92;p = 0.026)。大多数皮肤病诊断基于临床,中度强效外用皮质类固醇是最常用的处方药。由于转诊中慢性皮肤疾病占主导,因此需要反复进行随访预约。