Dermatology is primarily an outpatient speciality, but significant numbers of patients are admitted either for inpatient treatment or diagnostic work up in dermatology wards. Reviews of inpatient dermatology admissions are limited in the current medical literature. In our setting, no studies have been conducted to evaluate the clinical spectrum and outcome of dermatology inpatients.
Purpose of the study
The purpose of the study was to describe the clinical spectrum and outcome of inpatients admitted to dermatology wards at King Edward VIII Hospital in Durban, KwaZulu-Natal.
We performed a retrospective study of records of patients admitted to dermatology wards between January 2012 and December 2013. Records were analyzed for age, gender, length of stay, dermatologic disease, investigations and discharge plan.
A total of 108 patients’ charts were reviewed. Of the admissions 52.8 % (n=57) were female and 47.2% (n=51) were male. The mean age was 34 (range 1-79 years). The average length of stay was 9 days, with a median of 7 days. The most common diagnoses made were Steven Johnson Syndrome and atopic dermatitis at 19, 4% and 12, 0% respectively. Other skin conditions included autoimmune blistering dermatoses (6.5%), psoriasis (5.6%), extensive viral infections (5.6%), deep fungal infections (5.6%), Steven Johnson Syndrome-Toxic Epidermal Necrolysis Overlap (SJS-TEN) Syndrome (4.6%), sebo-psoriasis (4.6%), Kaposi sarcoma (2.8%), severe bacterial infections (0.9%),
mycosis fungoides (0.9%) and HPV (0.9%).
The investigations that were retrievable from the charts of our patients (adults and children) included FBC/Diff (99%), U&E/LFT (97%), CXR (98%), HIV (35%), biopsy (23%), sputum for AFB (1.9%) and PCT (1.9%). Ninety eight percent of patients had a Chest X-ray recorded in their charts. It was documented in the charts that the Chest X-ray was done as a screening test for pulmonary TB owing to the high prevalence of both HIV and tuberculosis in our setting. Of all the admissions, 85% (n=92) were discharged and given a follow up date, 6% (n=6) were referred to other departments and 9% (n=10) died
The two-year retrospective study, documented the spectrum and outcome of skin conditions in patients admitted to dermatology wards at King Edward VIII Hospital, Durban.
Stevens Johnson Syndrome and atopic dermatitis were the most common reasons for admission. It is important that outpatient management and early diagnoses is optimized to avert costly and unnecessary admissions, thereby reducing morbidity and mortality which may be triggered by nosocomial infections. Timeous referral is key to the positive outcome and this can be achieved by educating primary health caregivers to identify and refer relevant cases promptly.||en_US