Dermatological consultations in an observation unit of an emergency department in Italy

Drago, Francesco; Gasparini, Giulia; Signori, Alessio; Campisi, C.; Cozzani, Emanuele; Parodi, Aurora

doi:10.1111/jdv.12744

Cited by 15 publications

(42 citation statements)

References 16 publications

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“…This female predominance was obvious for all age groups except for patients aged between 41 and 60 years. This observation is in line with previous studies showing that female patients exhibit greater unease and concern with skin-related disorders [10, 15, 16]. …”

Section: Discussionsupporting

confidence: 82%

“…Unlike other studies [10], where there was a majority of women, in our series most hospitalized patients were men, in agreement with the findings by Bancalari-Díaz et al [15]. Consistent with previous reports, bacterial infectious diseases, including erysipelas and cellulitis, constituted the most frequent cause resulting in hospitalization [5, 10, 15, 16]. …”

Section: Discussionsupporting

confidence: 79%

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Emergency Consultations in Dermatology in a Secondary Referral Hospital in Southern Switzerland: A Prospective Cross-Sectional Analysis

et al. 2019

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Background/Aims: The spectrum of dermatological emergencies is broad. Only a few studies have assessed the profile of dermatological conditions resulting in an emergency visit in a referral hospital. We sought to assess the conditions prompting an urgent dermatological visit and to compare the diagnoses with those made during the regular scheduled encounters. Methods: We performed a cross-sectional study of all patients with a cutaneous problem attending our emergency consultation during a 7-month period. The study variables were gender, age, duration of symptoms, diagnosis, need for hospitalization and/or follow-up. We further evaluated patients attending scheduled visits to compare the demographic characteristics and diagnoses between the two groups. Results: Six hundred fifty-two consecutive patients with an urgent dermatological consultation were included. Three hundred sixty (55.2%) were women and 292 (44.8%) were men. Infectious diseases (32.8%) as well as various forms of eczema (24.8%) constituted the most frequent causes for an emergency visit. Approximately 40% of emergency visits took place more than 1 week after the development of the cutaneous manifestations. The most frequent disorders seen in the 1,738 control patients included benign melanocytic and nonmelanocytic tumors (27.2%) and malignant skin lesions (11.5%). Conclusions: Our study indicates that the dermatological diagnoses in the emergency visits significantly differ from those of the routinely scheduled appointments. In a significant portion of patients, the use of an emergency consultation was not justified. This study provides support to the idea that a specific training is required to manage dermatological emergencies and that efforts should be made to reduce unjustified emergency visit use.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionsupporting

confidence: 79%

Emergency Consultations in Dermatology in a Secondary Referral Hospital in Southern Switzerland: A Prospective Cross-Sectional Analysis

et al. 2019

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“…Acil servislere başvuru nedeni olan dermatolojik sorunlar içinde erizipel ve selülit en ön sıralarda yer almaktadır (7,8).…”

Section: Discussionunclassified

Retrospective Evaluation of Risk Factors and Response in Treatment among Hospitalized Patients with Lower-Extremity Cellulitis

Mehdi¹,

Ekinci²,

Baykal³

2016

tdd

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Amaç: Bacak yerleşimli selülit olgularında risk faktörlerinin ortaya çıkarılması, risk faktörlerinin tedaviye etkisinin araştırılması ve parenteral antibiyotik tedavisi uygulanan hastalarda tedavi etkinliği ve uygun tedavi süresi konusunda fikir sahibi olunmasıdır. Yöntemler: İstanbul Üniversitesi İstanbul Tıp Fakültesi, Deri ve Zührevi Hastalıkları Anabilim Dalı'nda, 2009-2014 yılları arasında yatırılarak tedavi edilen alt ekstremite selüliti tanılı 46 hastada enfeksiyon açısından olası risk faktörleri, yatış sırasında kullanılan tedaviler, sonuçları ve tedavi sonrası izlemeye alınan hastalarda nüks gelişimi retrospektif olarak değerlendirildi. Bulgular: Tinea pedis (n=19), diabetes mellitus (n=12), baypas cerrahisi (n=6) ve kronik lenfödem (n=5) risk faktörleri olarak saptandı. Takibi olmayan bir hasta dışındakilerin tümünde tam iyileşme saptandı. Hastaların 39'unda (%84,8) tek başına parenteral ampisilin-sulbaktam kullanıldı. İntravenöz antibiyotik tedavi süresi ortalama 17,7±12,4 gün (ortanca: 14 gün) olarak tespit edildi. Ortalama 2 yıllık izlem süresinde 11 hastada (%32,4) nüks saptandı ve tinea pedis ile nüks arasında anlamlı ilişki bulundu. Sonuç: Tinea pedis ve kronik lenfödem birden fazla atak oluşumunda risk faktörleri olarak saptandı. Parenteral antibiyotik tedavisi, bu amaçla da "tek başına ampisilin-sulbaktam" en sık kullanılan tedavi şekli olup alt ekstremite selülitinde çok yüksek oranda etkili bulundu. İyileşme için gerekli ortalama süre başka çalışmalara göre biraz uzun bulundu. Çalışmanın çoğunlukla dirençli ve komplike hastaların başvurduğu üçüncü basamak bir tedavi merkezinde gerçekleşmiş olması veya ülkemizdeki olası bir antibiyotik direnci bu sonuçta rol oynamış olabilir. Results: Tinea pedis (n=19), diabetes mellitus (n=12), by-pass surgery (n=6), and chronic lymphedema of the legs (n=5) were detected as main risk factors. Improvement with systemic therapy was seen in all patients except one patient who was lost to follow-up. Thirty nine of the patients (84.8%) were treated with parenteral ampicillin-sulbactam. The mean duration of parenteral antibiotic therapy was 17.7±12.4 (median: 14) days. In 11 patients (32.4%), recurrence was detected, during an average follow-up of 2 years. There was a significant correlation between tinea pedis and recurrence. Conclusion: Tinea pedis and chronic lymphedema were main risk factors for multiple attacks. Parenteral antibiotic treatment mostly used as the single drug regimen with ampicillinsulbactam was highly effective. Relatively longer duration of treatment in our patients has been attributed to the facts that being a tertiary medical center, dealing mostly with therapy resistant and high risk patients of cellulitis or antibiotic resistance in our country.

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“…Indessen werden Patienten, die unsere dermatologische Notfallambulanz in Anspruch nehmen, mit dem gleichen Aufwand und den gleichen Ressourcen versorgt wie Patienten, die einen regulären Ambulanztermin haben. Dieses Ungleichgewicht wirft Fragen nach dem „Status“ der Notfallpatienten auf: Was genau ist ein dermatologischer Notfall ? Sollten bei Notfallkonsultationen nur die notwendigsten diagnostischen Tests (und anschließenden Behandlungen) vorgenommen werden und die umfassende dermatologische Abklärung durch den jeweiligen niedergelassenen Arzt erfolgen?…”

Section: Diskussionunclassified

“…Diese Ergebnisse sind teilweise kongruent mit den Diagnosen, die in anderen Studien angegeben werden. Wir sahen allerdings weniger Patienten mit bakteriellen Infektionen und, einen aktuellen Trend widerspiegelnd, mehr Skabiesinfektionen . Im Vergleich zu anderen Studien beobachteten wir auch weniger Patienten mit Urtikaria, Angioödem und Insektenstichen sowie weniger Fälle von Arzneimittelexanthemen und Vaskulitiden .…”

Section: Diskussionunclassified

Für dermatologische Notfallpatienten benötigte Ressourcen: Eine zwölfmonatige prospektive Datenerhebung aus Deutschland

Ansorge

Miocic

Bubnoff

et al. 2019

J Deutsche Derma Gesell

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Zusammenfassung Hintergrund und Ziele Die steigenden Zahlen von Patienten, die Notfalleinrichtungen aufsuchen, sind mit einem zunehmenden Bedarf an Material und Personal verbunden. Um diese Ressourcen besser quantifizieren zu können, haben wir die diagnostischen Verfahren, die Art der Behandlung und die Anzahl und den Ausbildungsstand der Mitarbeiter untersucht, die an Notfallkonsultationen beteiligt sind. Patienten und Methoden Die Studie wurde als monozentrische prospektive Beobachtungsstudie über zwölf Monate an der dermatologischen Klinik eines deutschen Universitätskrankenhauses durchgeführt. In die konsekutive Stichprobe wurden 3155 Konsultationen eingeschlossen. Ergebnisse Bei 29 % aller Konsultationen wurden diagnostische Tests wie z.B. mikrobiologische Abstriche, Blutuntersuchungen oder Stanzbiopsien durchgeführt. In 70 % der Fälle verordneten die Ärzte eine Therapie, wobei Steroide und Antihistaminika die häufigsten topischen und systemischen Therapeutika waren. Alle Patienten wurden von mindestens einem Arzt und einer Pflegekraft versorgt, in 25 % der Fälle war ein weiterer Arzt beteiligt. Bei der überwiegenden Mehrzahl der Fälle reichten weniger als 30 Minuten für die Konsultation aus. Im Durchschnitt nahmen Notfallkonsultationen pro Tag zwei Stunden der Arbeitszeit des behandelnden Arztes in Anspruch. Die Arbeitszeit anderer beteiligter Mitarbeiter wie Pflegekräfte oder Laboranten wurde dabei nicht miteinbezogen. Schlussfolgerungen Diese Studie gibt einen Einblick in den Umfang der Ressourcen, die bei dermatologischen Notfallkonsultationen aufgewendet werden.

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Dermatological consultations in an observation unit of an emergency department in Italy

Abstract: Given constraints involved in health care today, it is crucial to understand which dermatological presentations are 'true emergencies'. In such a scenario knowing the epidemiology of dermatological emergencies and the alarming skin signs and symptoms might be useful.

Cited by 15 publications

References 16 publications

Emergency Consultations in Dermatology in a Secondary Referral Hospital in Southern Switzerland: A Prospective Cross-Sectional Analysis

Emergency Consultations in Dermatology in a Secondary Referral Hospital in Southern Switzerland: A Prospective Cross-Sectional Analysis

Retrospective Evaluation of Risk Factors and Response in Treatment among Hospitalized Patients with Lower-Extremity Cellulitis

Für dermatologische Notfallpatienten benötigte Ressourcen: Eine zwölfmonatige prospektive Datenerhebung aus Deutschland

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