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Prevalence of cutaneous findings in hospitalized pediatric patients
J N Hubert1, J P Callen, J S Kasteler
1Department of Dermatology, University of Louisville, Kentucky, USA.
Insights
Cutaneous abnormalities are prevalent in hospitalized children, with 95% showing findings like rashes or congenital lesions. However, physicians often underdiagnose or overlook these skin conditions, impacting patient care.
Area of Science:
- Pediatric Dermatology
- Hospital Medicine
- Diagnostic Accuracy
Background:
- Cutaneous findings are crucial for diagnosing and treating hospitalized patients.
- Identifying skin abnormalities can significantly improve diagnostic accuracy and patient outcomes.
- The prevalence and clinical significance of skin conditions in pediatric hospital admissions require further investigation.
Purpose of the Study:
- To determine the prevalence of cutaneous abnormalities in hospitalized pediatric patients.
- To assess how often these skin findings are noted and diagnosed by the admitting medical team.
- To evaluate the impact of dermatologic findings on primary diagnosis and treatment plans.
Main Methods:
- A prospective study involving 110 pediatric patients admitted to Kosair Children's Hospital in January 1995.
- Random selection of children with medical problems for skin examinations within 24-28 hours of admission.
- Documentation of physical findings, physician charting completeness, and the relationship of cutaneous findings to the admitting diagnosis.
Main Results:
- 95% of the 110 patients (105) exhibited cutaneous findings, such as rashes or congenital lesions.
- Dermatitis, pigmented lesions, and congenital vascular malformations were the most common diagnoses.
- In 8% of cases, dermatologic findings altered the primary diagnosis or treatment, yet only 63% of relevant skin issues were noted by admitting physicians.
Conclusions:
- Cutaneous abnormalities are highly common in hospitalized pediatric patients.
- The diagnosis, charting, and treatment of dermatologic conditions by the primary pediatric team are frequently incomplete.
- Expert dermatologic examination is critical for accurate diagnosis and effective patient care in pediatric hospital settings.
Abstract:
Cutaneous findings can be useful in establishing the diagnosis and treatment of hospitalized patients. Observation and identification of cutaneous abnormalities can improve the accuracy of diagnosis and result in improved patient care. We set out to determine the prevalence of cutaneous abnormalities in hospitalized pediatric patients in a hospital and how often these findings were noted and properly diagnosed by the admitting team of physicians. Children with medical problems admitted to Kosair Children's Hospital during the month of January 1995 were randomly selected for a skin examination, which was performed within 24 to 28 hours of admission. Parental consent was required prior to admission into the study. Of 117 patients offered participation, 110 accepted. Physical findings were noted and in addition the completeness of charting by the admitting physician and the relationship of any cutaneous findings to admitting diagnosis were noted. One hundred five of the 110 patients (95%) had cutaneous findings consisting of either a "rash" or a "congenital lesion." Fifty-one had more than one cutaneous finding noted on examination. Dermatitis was the most common diagnosis made, followed by pigmented lesions and congenital vascular malformations of all types. In 35 of the 105 patients with a dermatologic diagnosis, the dermatologic diagnosis related directly to the admitting diagnosis. In only 22 of these 35 (63%) was the cutaneous involvement noted by the admitting physician. In 9 of the 110 cases (8%), the findings on dermatologic examination altered the primary diagnosis and/or treatment. Cutaneous findings are very common in the hospitalized pediatric patient. The diagnosis, charting, and treatment of dermatologic conditions by the primary pediatric team were often incomplete, although an expert cutaneous examination can be critical to patient care.