Fayne R, Castillo D E, Sanchez N, Burroway B, Nanda S, De Bedout V, Stratman S, Rosen J, Darwin E, Nagrani N, Gonzalez A, Paul S, Maderal A, Elgart G, Kirsner R, Nichols A
Dr. Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
J Eur Acad Dermatol Venereol. 2020 Sep;34(9):2120-2126. doi: 10.1111/jdv.16565. Epub 2020 Jun 22.
Dermatology consultations in the inpatient hospital setting can improve diagnostic accuracy and management.
Characterize dermatologic diagnostic and treatment trends in the hospital setting and identify variables that may affect patient care.
Retrospective chart review from 1 January 2012 to 31 December 2017 at Jackson Memorial Hospital (JMH) (Miami, Florida, USA), an academic non-profit tertiary care centre affiliated with University of Miami Miller School of Medicine, was performed. Patients who received dermatology consultations in the emergency department (ED) or inpatient settings were included. Patient demographics, admission information, provisional diagnosis and management plans by primary teams, final diagnosis, management plans and testing recommendations by the dermatology consults team, and follow-up information were collected. Analysis using Microsoft Excel of how time to consultation, admission length, inpatient versus ED setting and primary team affected diagnostic accuracy was also performed.
The 1004 consultations for 812 patients (n = 812) were reviewed (359 women, 453 men). Most patients were Hispanic (n = 359; 44.2%) or African American (n = 273; 33.6%). Mean admission length was 20.6 days (range 0-439; median 6). The most common consulting service was internal medicine (n = 452). In 387 cases (47.6%), primary teams did not give a provisional diagnosis. The most common provisional diagnoses were bacterial infection (n = 93), viral infection (n = 49) and drug reaction (n = 44). The most common diagnoses by dermatology were viral infection (n = 93), bacterial infection (n = 90) and drug reaction (n = 80). Dermatology consultation changed the provisional diagnosis in 55.7% of cases, more often in cases where consultation took place ≥2 days after admission (P < 0.05). Primary teams followed dermatology treatment recommendations in 85.2% of cases.
Dermatology consultation improves diagnostic accuracy in skin disorders in the hospital setting and serves as a valuable resource for inpatient care. A notable aspect of data from this study is the unique patient population, predominantly comprised of underrepresented racial and ethnic minorities including Hispanics and African Americans.
在住院医院环境中进行皮肤科会诊可提高诊断准确性和管理水平。
描述医院环境中皮肤科的诊断和治疗趋势，并确定可能影响患者护理的变量。
对美国佛罗里达州迈阿密杰克逊纪念医院（JMH）进行回顾性病历审查，该医院是与迈阿密大学米勒医学院相关的学术性非营利三级护理中心，审查时间为2012年1月1日至2017年12月31日。纳入在急诊科（ED）或住院环境中接受皮肤科会诊的患者。收集患者人口统计学资料、入院信息、初级团队的初步诊断和管理计划、最终诊断、皮肤科会诊团队的管理计划和检测建议以及随访信息。还使用Microsoft Excel分析会诊时间、住院时长、住院与急诊环境以及初级团队如何影响诊断准确性。
对812例患者的1004次会诊进行了审查（359名女性，453名男性）。大多数患者为西班牙裔（n = 359；44.2%）或非裔美国人（n = 273；33.6%）。平均住院时长为20.6天（范围0 - 439天；中位数6天）。最常见的会诊科室是内科（n = 452）。在387例（47.6%）病例中，初级团队未给出初步诊断。最常见的初步诊断为细菌感染（n = 93）、病毒感染（n = 49）和药物反应（n = 44）。皮肤科最常见的诊断为病毒感染（n = 93）、细菌感染（n = 90）和药物反应（n = 80）。皮肤科会诊在55.7%的病例中改变了初步诊断，在入院≥2天后进行会诊的病例中更常见（P < 0.05）。初级团队在85.2%的病例中遵循了皮肤科的治疗建议。
皮肤科会诊提高了医院环境中皮肤疾病的诊断准确性，并成为住院护理的宝贵资源。本研究数据的一个显著方面是独特的患者群体，主要由代表性不足的种族和族裔少数群体组成，包括西班牙裔和非裔美国人。
