Penn State Health, Department of Family and Community Medicine, Hershey, Pennsylvania.
Penn State College of Medicine, Department of Public Health Science, Hershey, Pennsylvania.
West J Emerg Med. 2022 Jun 30;23(4):481-488. doi: 10.5811/westjem.2022.March.55516.
Poison ivy (toxicodendron) dermatitis (TD) resulting from contact with poison ivy, oak, or sumac is a common form of allergic contact dermatitis that impacts millions of people in the United State every year and results in an estimated 43,000 emergency department (ED) visits annually. Our objective in this study was to evaluate whether healthcare utilization outcomes are impacted by prescription practices of systemic corticosteroids.
We used a health claims database from 2017-2018 of those treated for TD. Descriptive statistics and logistics regression models were used to characterize trends.
We included in this analysis 115,885 claims from 108,111 unique individuals (93.29%) with 7,774 (6.71%) return claims within 28 days. Of the return claims, 470 (6.05%) were to the ED. Emergency clinicians offered no oral corticosteroid prescription 5.27% (n = 3,194) of the time; 3276 (86.26%) prescriptions were for a duration of 1-13 days, 410 (10.80%) were for 14-20 days, and 112 (2.95%) were for >21 days. Further, we found that shorter duration oral corticosteroids (odds ratio [OR] 1.30; 95% confidence interval 1.17-1.44; P <0.001) and initial treatment for TD at the ED compared to primary care clinicians (OR 0.87 [0.80, 0.96]; P <0.001) and other non-dermatologists (OR 0.89 [0.80, 0.98]; P = 0.01) places patients at an increased risk for return visits with healthcare clinicians when controlling for drug group, duration of treatment, and initial treatment location.
Despite recommendations to treat TD with oral steroids for at least 14 days, most emergency clinicians offered this treatment for shorter durations and was associated with return visits. Emergency clinicians should consider treatment of two to three weeks when providing systemic steroid coverage when there are no limiting contraindications, especially as patients who present to the ED may do so with more severe disease. Additional education may be needed on appropriate treatment pathways for TD to reduce healthcare utilization associated with undertreatment.
接触毒葛、毒橡木或毒漆树引起的毒葛性皮炎（TD）是一种常见的过敏性接触性皮炎，每年影响美国数百万人，并导致每年约有 43000 人到急诊部（ED）就诊。我们在这项研究中的目的是评估系统皮质类固醇的处方实践是否会影响医疗保健的使用结果。
我们使用了 2017-2018 年接受 TD 治疗的患者的健康索赔数据库。使用描述性统计和逻辑回归模型来描述趋势。
我们对 115885 项索赔进行了分析，涉及 108111 名独特个体（93.29%），其中 7774 名（6.71%）在 28 天内有复诊。在复诊中，470 人（6.05%）到 ED 就诊。急诊临床医生提供的口服皮质类固醇处方有 5.27%（n = 3194）的时间没有；3276 次（86.26%）处方的持续时间为 1-13 天，410 次（10.80%）处方的持续时间为 14-20 天，112 次（2.95%）处方的持续时间超过 21 天。此外，我们发现，较短时间的口服皮质类固醇（比值比[OR] 1.30；95%置信区间 1.17-1.44；P <0.001）和在 ED 而不是初级保健临床医生处接受初始 TD 治疗（OR 0.87 [0.80, 0.96]；P <0.001）以及其他非皮肤科医生（OR 0.89 [0.80, 0.98]；P = 0.01）会增加患者在控制药物种类、治疗持续时间和初始治疗位置的情况下因医疗保健就诊而复诊的风险。
尽管建议使用口服类固醇治疗 TD 至少 14 天，但大多数急诊临床医生提供的这种治疗时间较短，并且与复诊有关。在没有限制禁忌证的情况下，急诊临床医生在提供全身性类固醇治疗时应考虑治疗两到三周，特别是因为到 ED 就诊的患者可能患有更严重的疾病。可能需要进行更多关于 TD 适当治疗途径的教育，以减少因治疗不足而导致的医疗保健使用。
