Pediatric Inpatient and Emergency Dermatology Consultations: A 5-Year Retrospective Analysis

Objective: To characterize and analyze the inpatient and emergency pediatric dermatology consults in our academic hospital center. Methods: We reviewed 485 consultations that were done by the University of Puerto Rico Department of Dermatology from July 2007 to June 2012. The date, patient age and gender, consulting service, presumptive diagnosis, final diagnosis, and diagnostic procedures performed were documented for each consult. Results: The patients' ages ranged from newborn to 18 years; the 13 to 18 years age group was the most common (29%). Dermatology consults were requested by the general pediatrics ward, primarily (32%), followed by the emergency room (25%). In 236 cases (48.6%), a vague diagnostic impression was provided by the consulting service, whereas in 249 (51.4%) cases, a specific or differential diagnosis was provided. The dermatology service changed the diagnosis in 12% (58/249) of the evaluated cases. The most common misdiagnoses were allergic contact dermatitis, drug eruption, papular urticaria, nutritional deficiency, atopic dermatitis, seborrheic dermatitis, cellulitis, and herpes infection. The most common diagnoses encountered were inflammatory skin conditions, infectious diseases, and drug eruptions. Skin biopsy was the most common procedure performed. In 30% of the cases, more than 1 procedure was performed as part of the evaluation work-up. Conclusion: Our study demonstrates the important role of the dermatologist in the diagnosis and management of pediatric patients with dermatological diseases. The information contained within this manuscript should contribute to raising the awareness of pediatricians regarding the most common dermatological diagnoses in this patient population.