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]	Weiming Wu, Min Li, Huilin Jiang, Min Sun, Yongcheng Zhu, Gongxu Zhu, Yanling Li, Yunmei Li, Junrong Mo, Xiaohui Chen, Haifeng Mao. Development of an emergency department length-of-stay prediction model based on machine learning [J]. World Journal of Emergency Medicine, 2025, 16(3): 220-224.
[2]	Jingyuan Xie, Jiandong Gao, Mutian Yang, Ting Zhang, Yecheng Liu, Yutong Chen, Zetong Liu, Qimin Mei, Zhimao Li, Huadong Zhu, Ji Wu. Prediction of sepsis within 24 hours at the triage stage in emergency departments using machine learning [J]. World Journal of Emergency Medicine, 2024, 15(5): 379-385.
[3]	Payush Chatta, Brian Diep, Jakrin Kewcharoen, Daniel Rossie, Cory Toomasian, Purvi Parwani, Dmitry Abramov. The diagnostic yield for computed tomography pulmonary angiography in patients with anticoagulation [J]. World Journal of Emergency Medicine, 2024, 15(4): 251-255.
[4]	Jie Er Janice Soo, Yuan Helen Zhang, Gek Hsiang Lim, Fatimah Lateef. Bicycle-related traumatic injuries: a retrospective study during COVID-19 pandemic [J]. World Journal of Emergency Medicine, 2024, 15(4): 256-262.
[5]	Rex Pui Kin Lam, Zonglin Dai, Eric Ho Yin Lau, Carrie Yuen Ting Ip, Ho Ching Chan, Lingyun Zhao, Tat Chi Tsang, Matthew Sik Hon Tsui, Timothy Hudson Rainer. Comparing 11 early warning scores and three shock indices in early sepsis prediction in the emergency department [J]. World Journal of Emergency Medicine, 2024, 15(4): 273-282.
[6]	Jonathan Chabon, Jemer Garrido, Deanna Schreiber-Gregory, Jefferson Drapkin, Sergey Motov. Trends in oxycodone and oxycodone-containing analgesics administration for back pain in emergency departments in the USA (2007-2018) [J]. World Journal of Emergency Medicine, 2024, 15(3): 169-174.
[7]	Yedalm Yoo, Shin Ahn, Bora Chae, Won Young Kim. Performance of the EDACS-ADP incorporating high-sensitivity troponin assay: Do components of major adverse cardiac events matter? [J]. World Journal of Emergency Medicine, 2024, 15(3): 175-180.
[8]	Diogo de Almeida Fernandes, Guilherme de Freitas Camões, Diana Ferreira, Carolina Queijo, Carlos Fontes-Ribeiro, Lino Gonçalves, Rui Pina, Natália António. Prevalence and risk factors for acquired long QT syndrome in the emergency department: a retrospective observational study [J]. World Journal of Emergency Medicine, 2023, 14(6): 454-461.
[9]	Fady Y. Hijji, Andrew D. Schneider, Matthew D. Thomas, Joseph G. Lyons, Daniel D. Bohl, Jennifer L. Jerele, Michael J. Prayson. Knowledge of radiation exposure associated with common trauma imaging modalities among orthopaedic surgeons, emergency medicine physicians, and general surgeons in the United States [J]. World Journal of Emergency Medicine, 2023, 14(4): 294-301.
[10]	Xinlei Wang, Yao Sun, Xiaoyu Ni, Shu Zhang. Development and validation of an emergency bloodstream infection score for predicting in-hospital mortality in patients with community-acquired bloodstream infections [J]. World Journal of Emergency Medicine, 2023, 14(4): 280-286.
[11]	Ahmed Faidh Ramzee, Ayman El-Menyar, Mohammad Asim, Ahad Kanbar, Khalid Ahmed, Bahaa Daoud, Saji Mathradikkal, Ahmad Kloub, Hassan Al-Thani, Sandro Rizoli. The impact of emergency department length of stay on the outcomes of trauma patients requiring hospitalization: a retrospective observational study [J]. World Journal of Emergency Medicine, 2023, 14(2): 96-105.
[12]	Jee Yen Kuck, Abdul Muhaimin Noor Azhar, Neena Wee, Rishya Manikam. Diagnostic accuracy of the tongue blade test combined with clinical signs to detect maxillary and mandibular fractures in the emergency department [J]. World Journal of Emergency Medicine, 2023, 14(2): 122-127.
[13]	Guang-mei Wang, Yong Li, Shuo Wu, Wen Zheng, Jing-jing Ma, Feng Xu, Jia-qi Zheng, He Zhang, Jia-li Wang, Yu-guo Chen. The combination of creatine kinase-myocardial band isoenzyme and point-of-care cardiac troponin/ contemporary cardiac troponin for the early diagnosis of acute myocardial infarction [J]. World Journal of Emergency Medicine, 2022, 13(3): 163-168.
[14]	Ittai Shichman, Or Shaked, Shai Factor, Ahuva Weiss-Meilik, Amal Khoury. Emergency department electric scooter injuries after the introduction of shared e-scooter services: A retrospective review of 3,331 cases [J]. World Journal of Emergency Medicine, 2022, 13(1): 5-10.
[15]	Ralphe Bou Chebl, Nader El Souki, Mirabelle Geha, Imad Majzoub, Rima Kaddoura, Hady Zgheib. Two-point compression ultrasonography: Enough to rule out lower extremity deep venous thrombosis? [J]. World Journal of Emergency Medicine, 2021, 12(4): 268-273.