Prednisone prescribing habits in the emergency room to treat rash

Background: A visiting dermatologist at a small community hospital in Northern BC observed an increase in the number of patients who were treated with prednisone for skin rash following an ER consult. In some cases, this was considered to be inappropriate and/or there was inadequate follow-up. The primary purpose of this study was to determine the prevalence with which prednisone was prescribed for nonspecific dermatology diagnoses in ER patients at the University Hospital of Northern BC (UHNBC), and the prevalence of follow-up referrals for those patients. Methods: A retrospective medical chart review of patient visits to the UHNBC ER that presented with "rash and other nonspecific skin eruption" between 1 January 2016 and 31 December 2018 was conducted. Results: Of those patients who were diagnosed with nonspecific rash in the ER (N = 463), 10.4% were prescribed prednisone. Most of those patients received nonspecific (45.8%) or uncertain (25.0%) diagnoses; 29.2% were given specific diagnoses. Most patients who were prescribed prednisone received a follow-up referral to a family physician (56.3%) or were referred to other health care providers (4.2%), a family physician who had an interest in dermatology (2.1%), or a dermatologist (2.1%). The rest did not receive a follow-up referral (35.4%). Conclusions: We suspect that prednisone was used empirically to treat nonspecific or uncertain diagnoses of skin rashes in the UHNBC ER. This may have been related to a limited availability of dermatology services and support, and suggests a need for further education on using current guidelines for treating dermatological conditions and the importance of providing follow-up referrals for patients treated with prednisone.