Nedorost Susan
Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA,
Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH 44106 USA,
Clin Cosmet Investig Dermatol. 2018 Oct 31;11:545-549. doi: 10.2147/CCID.S185357. eCollection 2018.
Generalized dermatitis (defined as histological spongiotic dermatitis affecting more than three anatomical areas of the skin surface) has many potential causes that mimic atopic dermatitis and contact dermatitis. If a treatable cause is missed, the patient may be treated with chronic immunosuppressive therapy that carries more risk than specific treatment for a disease mimicking dermatitis. Checklists have been shown to improve patient safety, primarily in procedural contexts. This work assessed the utility of a diagnostic checklist for subacute and chronic generalized dermatitis in patients who had not improved after at least 1 month of avoidance of contact allergens identified by comprehensive patch testing, if indicated.
Designed as a quality improvement project using Standards for Quality Improvement Reporting Excellence (SQUIRE) guidelines, a diagnostic checklist was used by the principal investigator for 1 year in a tertiary referral dermatitis clinic for patients without a confirmed cause for the dermatitis after two to three visits with the investigator. All patients had had diagnostic patch testing if indicated. Almost all had undergone skin biopsy by their referring provider. Fifteen patients met the criteria for inclusion in this study. Outcome measures included provider and patient perception of efficiency and/or confusion caused by the checklist. Length of time from the initiation of use of the checklist to final diagnosis was recorded. Additional diagnoses considered that were not included in the initial checklist were added to the checklist during the course of the study.
The checklist was useful in improving diagnostic efficiency (prompting consideration of diagnoses not otherwise considered upon initiation of the visit that resulted in a final plan of care) in these complex cases of recalcitrant dermatitis. Open utilization of the checklist by the investigator during the clinical encounter was well accepted by patients and families.
Checklists can be useful for complex cognitive diagnostic work.
University Hospitals Cleveland Medical Center Institutional Review Board # 11-15-34.
泛发性皮炎（定义为组织学上的海绵状皮炎累及皮肤表面三个以上解剖区域）有许多可能的病因，可模仿特应性皮炎和接触性皮炎。如果遗漏了可治疗的病因，患者可能会接受慢性免疫抑制治疗，而这种治疗比针对模仿皮炎的疾病进行特异性治疗的风险更高。检查表已被证明可提高患者安全性，主要是在手术环境中。这项研究评估了诊断检查表对亚急性和慢性泛发性皮炎患者的效用，这些患者在根据需要进行全面斑贴试验确定的接触性过敏原回避至少1个月后仍未改善。
作为一项使用卓越质量改进报告标准（SQUIRE）指南的质量改进项目，主要研究者在一家三级转诊性皮炎诊所对未确诊皮炎病因的患者使用诊断检查表1年，这些患者在与研究者进行两到三次就诊后仍未确诊。所有患者根据需要进行了诊断性斑贴试验。几乎所有患者都由转诊医生进行了皮肤活检。15名患者符合本研究的纳入标准。结果指标包括提供者和患者对检查表所导致的效率和/或困惑的感知。记录从开始使用检查表到最终诊断的时间长度。在研究过程中，将最初检查表未包括但考虑到的其他诊断添加到检查表中。
检查表有助于提高这些顽固性皮炎复杂病例的诊断效率（促使在就诊开始时考虑其他未考虑的诊断，从而形成最终的护理计划）。研究者在临床会诊期间对检查表的开放使用得到了患者和家属的良好接受。
检查表对复杂的认知诊断工作可能有用。
克利夫兰大学医院医学中心机构审查委员会#11-15-34。
