Presenting patterns of dermatology conditions to an Australian emergency department

doi:10.5847/wjem.j.1920-8642.2020.02.002

Abstract

Abstract:

BACKGROUND: Approximately 5%-8% of emergency department (ED) presentations are due to a dermatological condition. This study aimed to identify and characterise patients with skin conditions presenting to a busy ED.

METHODS: A 5-year retrospective study on patients with dermatological conditions presenting to the Princess Alexandra Hospital ED in Brisbane, Australia was performed. Electronic medical records were used to compare demographics and admission status of the dermatology group and the total ED group presentations. A prospective survey was conducted on low priority triage (triage 4 and 5) patients identifying reasons presenting to the ED.

RESULTS: Of a total 281,718 ED presentations, 11,748 dermatology presentations were identified between January 2012 to December 2016. Of the dermatology presentations, 41.5% were female and had an average age of 47. The most common dermatology presentations were cellulitis, abscess, rash unspecified, and ulcer. Of those admitted, 36% were female, average age was 53, mean length of stay of 294 minutes and 83.1% had an infectious aetiology. Of triage 4 and 5 presentations, 66% patients we approached had been seen by a health practitioner prior to coming to the ED.

CONCLUSION: Within the population presenting with a skin related condition to the Princess Alexandra Hospital ED, characteristics associated with admission include male sex, older age, and an infectious etiology. This data may help ED clinicians decide on the discharge disposition of these patients. There may be a role for streamlined admissions for skin related infections, or improved hospital in the home services to support this group.

Key words: Pcellulitis, Skin, Dermatology, Emergency department

Emily Shao, Chantelle Judge, Erin McMeniman, Tina Bazianas, Rob Eley. Presenting patterns of dermatology conditions to an Australian emergency department[J]. World Journal of Emergency Medicine, 2020, 11(2): 74-78.

Figures/Tables 2

Table 1

Table 2

References 16

1	Lai-Kwon JE, Weiland TJ, Jelinek GA, Chong AH. Which patients with dermatological conditions are admitted via the emergency department? Australas J Dermatol. 2014; 55(4):255-9. pmid: 24359576
2	Wallett A, Sidhu S. Management pathway of skin conditions presenting to an Australian tertiary hospital emergency department. Australas J Dermatol. 2012; 53(4):307-10. pmid: 22671431
3	Lai-Kwon J, Weiland TJ, Chong AH, Jelinek GA. Which dermatological conditions present to an emergency department in Australia? Emerg Med Int. 2014; 2014:463026. doi: 10.1155/2014/463026 pmid: 24800080
4	Hoonpongsimanont W, Sahota PK, Chen Y, Nguyen M, Louis C, Pena J, et al. Emergency department patient experience: Same location, same provider, different scores by different survey methods. World J Emerg Med. 2019; 10(3):138-44. pmid: 31171943
5	Masso M, Bezzina AJ, Siminski P, Middleton R, Eagar K. Why patients attend emergency departments for conditions potentially appropriate for primary care: Reasons given by patients and clinicians differ. Emerg Med Australas. 2007; 19(4):333-40. doi: 10.1111/j.1742-6723.2007.00968.x pmid: 17655636
6	Kim JY, Cho HH, Hong JS, Jin SP, Park HS, Lee JH, et al. Skin conditions presenting in emergency room in Korea: an eight-year retrospective analysis. J Eur Acad Dermatol Venereol. 2013; 27(4):479-85. doi: 10.1111/j.1468-3083.2012.04469.x pmid: 22339990
7	Martínez-Martínez ML, Escario-Travesedo E, Rodríguez-Vázquez M, Azaña-Defez JM, Martín de Hijas-Santos MC, Juan-Pérez-García L. Dermatology consultations in an emergency department prior to establishment of emergency dermatology cover. Actas Dermosifiliogr. 2011; 102(1):39-47. pmid: 21315860
8	Baibergenova A, Shear NH. Skin conditions that bring patients to emergency departments. Arch Dermatol. 2011; 147(1):118-20. doi: 10.1001/archdermatol.2010.246 pmid: 20855676
9	Wang E, Lim BL, Than KY. Dermatological conditions presenting at an emergency department in Singapore. Singapore Med J. 2009; 50(9):881-4. pmid: 19787176
10	Alpalhão M, Uva L, Soromenho G, Filipe P. Dermatological emergencies: one-year data analysis of 8,620 patients from the largest Portuguese tertiary teaching hospital. Eur J Dermatol. 2016; 26(5):460-4. doi: 10.1684/ejd.2016.2825 pmid: 27297693
11	David CV, Chira S, Eells SJ, Ladrigan M, Papier A, Miller LG, et al. Diagnostic accuracy in patients admitted to hospitals with cellulitis. Dermatol Online J. 2011; 17(3):1. pmid: 21426867
12	Gupta S, Sandhu K, Kumar B. Evaluation of emergency dermatological consultations in a tertiary care centre in North India. J Eur Acad Dermatol Venereol. 2003; 17(3):303-5. doi: 10.1046/j.1468-3083.2003.00690.x pmid: 12702071
13	Dinh MM, Berendsen Russell S, Bein KJ, Chalkley DR, Muscatello D, Paoloni R, et al. Statewide retrospective study of low acuity emergency presentations in New South Wales, Australia: who, what, where and why? BMJ Open. 2016; 6(5):e010964. pmid: 27165649
14	Lasschuit D, Kuzmich D, Caplan G. Treatment of cellulitis in hospital in the home: a systematic review. OA Dermatology. 2014; 2(1):2.
15	The Queensland Cabinet and Ministerial Directory. Queenslanders called on to keep EDs for emergencies ONLY [media statement] (2017 Apr 15) [cited 2019 May 26]. Available from: http://statements.qld.gov.au/Statement/2017/4/15/queenslanders-called-on-to-keep-eds-for-emergencies-only.
16	Morley C, Unwin M, Peterson GM, Stankovich J, Kinsman L. Emergency department crowding: A systematic review of causes, consequences and solutions. PLoS One. 2018; 13(8):e0203316. doi: 10.1371/journal.pone.0203316 pmid: 30161242

Variables	Dermatology patients (n=11,748)	Total ED patients (n=281,718)	P value
Sex (female)	4,874 (41.5)	121,541 (43.1)	P<0.001
Length of stay (minutes, mean±SD)	275.0±222.7	280.3±246.7	P=0.01
Age in years (years, mean±SD)	47.10±19.51	47.55±20	P=0.02
Time of arrival			P<0.001
08:01 to 16:00	6,615 (56.3)^*	132,139 (46.9)
16:01 to 24:00	3,922 (33.3)	107,263 (38.1)
00:01 to 08:00	1,211 (10.3)	42,231 (15.0)
Missing	0 (0)	85 (0.03)
Day of arrival			P<0.0001
Monday	1,946 (16.6)	43,826 (15.6)
Tuesday	1,797 (15.3)	41,317 (14.7)
Wednesday	1,666 (14.2)	39,894 (14.2)
Thursday	1,618 (13.8)	39,570 (14.0)
Friday	1,751 (14.9)	39,949 (14.2)
Saturday	1,447 (12.3)	38,162 (13.5)
Sunday	1,523 (13.0)	39,000 (13.8)
Seasons
Summer	3,291 (28)	73,316 (26)
Autumn	3,023 (25.7)	72,826 (25.9)
Winter	2,774 (23.6)	71,400 (25.3)
Spring	2,660 (22.6)	64,176 (22.8)
ATS			P<0.0001
Triage 1	28 (0.2)	5,892 (2.1)
Triage 2	843 (7.2)	56,664 (20.1)
Triage 3	4,415 (37.6)	140,340 (49.8)
Triage 4	4,982 (42.4)	63,341 (22.5)
Triage 5	1,480 (12.6)	15,462 (5.5)
Discharge destination			P<0.0001
Admitted as an inpatient	4,153 (35.4)	91,683 (32.5)
Admitted to short stay	1,428 (12.2)	43,146 (15.3)
Did not wait	441 (3.8)	13,835 (4.9)
Died in ED	2 (0)	367 (0.1)
Discharged from ED	5,695 (48.5)	130,604 (46.4)
Transferred to another hospital	25 (0.2)	1,831 (0.6)
Unknown	4 (0)	252 (0.1)

Variables	Number (%)
Sex (female)	36
Age in years (years, mean±SD)	45.51±19
Do you have a regular GP (Yes)	97 (97)
Is this condition new (Yes)	72 (72)
Did you consult a health professional before coming to ED (Yes)	66 (66)
Who did you see? (n=66)
GP	55 (83)
Nurse	4 (6)
Other Hospital or ED	3 (5)
Specialist	2 (3)
Allied Health	2 (3)
Did that health professional refer you to ED? (Yes)	60 (91)
If you were referred, did they send you with a letter? (Yes)	36 (60)
Reasons for attending the ED
My condition required immediate attention	20 (20)
My condition was too serious or complex to see a GP	7 (7)
Medical treatment is better at the ED	11 (11)
I wanted a second opinion	7 (7)
I did not want my GP to know about this particular health problem	1 (1)
I prefer to talk to a doctor I don’t know about my health problems	1 (1)
I am able to see a doctor and have any tests done all at the same place	6 (6)
My GP was closed	17 (17)
I wait too long at the GP	3 (3)
I can drop in at any time in the ED	1 (1)
It is easier for me to get to the ED than a GP	8 (8)
There is no charge to see a doctor at the ED	3 (3)
There is no charge for X-rays or medication at the ED	6 (6)
I prefer the ED environment	1 (1)
I am from out of town and it’s easier to see the ED	2 (2)
Other	6 (6)

[1]	Lori Stolz, Elaine Situ-LaCasse, Josie Acuña, Matthew Thompson, Nicolaus Hawbaker, Josephine Valenzuela, Uwe Stolz, Srikar Adhikari. What is the ideal approach for emergent pericardiocentesis using point-of-care ultrasound guidance? [J]. World Journal of Emergency Medicine, 2021, 12(3): 169-173.
[2]	Kasım Turgut, Erdal Yavuz, Mine Kayacı Yıldız, Mehmet Kaan Poyraz. Violence toward emergency physicians: A prospective-descriptive study [J]. World Journal of Emergency Medicine, 2021, 12(2): 111-116.
[3]	Marin Pavlov, Lucija Klobučar, Iva Klobučar, Kristina Žgela, Vesna Degoricija. Does shifting to professional emergency department staffing affect the decision for chest radiography? [J]. World Journal of Emergency Medicine, 2021, 12(2): 87-92.
[4]	Hady Zgheib, Aline El Zakhem, Cynthia Wakil, Mohamad Ali Cheaito, Rola Cheaito, Antoine Finianos, Ralphe Bou Chebl, Rima Kaddoura, Nader Al Souky, Imad El Majzoub. Role of urine studies in asymptomatic febrile neutropenic patients presenting to the emergency department [J]. World Journal of Emergency Medicine, 2021, 12(2): 99-104.
[5]	William Gilliam, Jackson F. Barr, Brandon Bruns, Brandon Cave, Jordan Mitchell, Tina Nguyen, Jamie Palmer, Mark Rose, Safura Tanveer, Chris Yum, Quincy K. Tran. Factors associated with refractory pain in emergency patients admitted to emergency general surgery [J]. World Journal of Emergency Medicine, 2021, 12(1): 12-17.
[6]	Rebekah Shaw, Erica Popovsky, Alyssa Abo, Marni Jacobs, Nicole Herrera, James Chamberlain, Andrea Hahn. Improving antibiotic prescribing in the emergency department for uncomplicated community-acquired pneumonia [J]. World Journal of Emergency Medicine, 2020, 11(4): 199-205.
[7]	Hai-jiang Zhou, Tian-fei Lan, Shu-bin Guo. Outcome prediction value of National Early Warning Score in septic patients with community-acquired pneumonia in emergency department: A single-center retrospective cohort study [J]. World Journal of Emergency Medicine, 2020, 11(4): 206-215.
[8]	Chuan-qi Ding, Yu-ping Zhang, Yu-wei Wang, Min-fei Yang, Sa Wang, Nian-qi Cui, Jing-fen Jin. Death and do-not-resuscitate order in the emergency department: A single-center three-year retrospective study in the Chinese mainland [J]. World Journal of Emergency Medicine, 2020, 11(4): 231-237.
[9]	Maybritt I. Kuypers, Adinda Klijn, Nieke E. Mullaart-Jansen, Frans B. Plötz. Availability and quality of procedural sedation and analgesia in emergency departments without emergency physicians: A national survey in the Netherlands [J]. World Journal of Emergency Medicine, 2020, 11(2): 69-73.
[10]	Zhenghong Liu, Mingwei Ng, Dinesh V. Gunasekeran, Huihua Li, Kishanti Ponampalam, R Ponampalam. Mobile technology: Usage and perspective of patients and caregivers presenting to a tertiary care emergency department [J]. World Journal of Emergency Medicine, 2020, 11(1): 5-11.
[11]	Wirachin Hoonpongsimanont, Preet Kaur Sahota, Yanjun Chen, Maria Nguyen, Christine Louis, Jonathan Pena, Andrew Wong, Maxwell Jen. Emergency department patient experience: Same location, same provider, different scores by different survey methods [J]. World Journal of Emergency Medicine, 2019, 10(3): 138-144.
[12]	Chang Pan, Xiao-ran Huang, Jiao-jiao Pang, Kai Cheng, Feng Xu, Yu-guo Chen. Trends in mortality of emergency departments patients in China [J]. World Journal of Emergency Medicine, 2019, 10(3): 152-155.
[13]	Rakesh Gupta, Isaac Siemens, Sam Campbell. The use of outcome feedback by emergency medicine physicians: Results of a physician survey [J]. World Journal of Emergency Medicine, 2019, 10(1): 14-18.
[14]	Elaine Situ-LaCasse, Ryan W. Grieger, Stephen Crabbe, Anna L. Waterbrook, Lucas Friedman, Srikar Adhikari. Utility of point-of-care musculoskeletal ultrasound in the evaluation of emergency department musculoskeletal pathology [J]. World Journal of Emergency Medicine, 2018, 9(4): 262-266.
[15]	Sarah E. Frasure, Amy F. Hildreth, Raghu Seethala, Heidi H. Kimberly. Accuracy of abdominal ultrasound for the diagnosis of small bowel obstruction in the emergency department [J]. World Journal of Emergency Medicine, 2018, 9(4): 267-271.