Westmead Dermatology Dermatology consultation has been shown to have a significant beneficial impact on admitted hospital patients with concurrent or newly diagnosed skin conditions. In this study, we aimed to determine the change in diagnosis and management after dermatology consultation at Westmead Hospital.
We analysed 306 consecutive consultations. In 44% of cases, the requesting team did not provide a diagnosis; in the cases where it did provide a diagnosis, it was changed 57.9% of the time. The most commonly misdiagnosed conditions were dermatitis or eczema (underestimated by the referring team) and skin infections (overestimated by the referring team). As an example, 12 of 18 cellulitis admitted to the hospital were not cellulitis and did not need systemic antibiotics. Although the referring teams diagnosed scabies in 7 cases and we could confirmed 5 of them, there were 5 undiagnosed cases of scabies within other reasons for referral. There were 38 cutaneous drug reactions but only 22 were diagnosed by the referring team. Additionally, the referring teams misdiagnosed 14 cutaneous drug reactions that were reclassified mainly as eczema/dermatitis and a few other conditions.
In summary, dermatologists established or changed management in 82% of cases.
The results of this review reinforce the value of dermatology input in the diagnosis and management of hospital inpatients. Ensuring maintained presence of hospital-based dermatologists has the potential to improve diagnosis and management of cutaneous issues early on; by extension, this can minimize unnecessary investigations, improve the quality of healthcare and reduce hospital burden.
You can read the whole report in:
Joseph, J., Truong, K., Smith, A. and Fernandez-Penas, P. (2021), Dermatology inpatient consultations in a tertiary hospital – a retrospective analysis. Int J Dermatol. https://doi.org/10.1111/ijd.15724
