Dermatology referrals in an East Asian tertiary hospital: a need for inpatient medical dermatology.
BACKGROUND
Within hospitals, there is a need for dermatological expertise, as hospitalized patients have a wider spectrum of severe and serious dermatological conditions, associated with significant morbidity.


OBJECTIVE
To characterize the patient profile and referral pattern of inpatient dermatology consultations, and to evaluate the diagnostic accuracy of non-dermatologists.


METHODS
This was a retrospective study reviewing all inpatient referrals for dermatology consultations during a 1-year period from July 2005 to June 2006 (inclusive), at the largest multi-disciplinary tertiary hospital in Singapore.


RESULTS
Of the 731 referrals made for dermatology consultations, 26.9% of patients had ≥ 3 important underlying comorbidities. Eczema/dermatitis (33.1%; n = 242) and cutaneous infections (23.4%; n = 171) accounted for over half of the dermatological consultations, followed by cutaneous adverse drug reactions (12.3%; n = 90). The provisional diagnoses of the referring doctors agreed with the final diagnoses confirmed by dermatologists in only 30.2% of all referrals; incorrect diagnoses were made in 35.2% of cases, and no provisional diagnoses were made in the remaining 34.6% of cases. Most misdiagnosed skin diseases were in fact common dermatoses (such as eczemas, cutaneous infections, drug rash) that required only standard treatment.


CONCLUSIONS
Our study reiterates the importance of inpatient medical dermatology in terms of both service and education. There should be continual efforts to ensure that dermatologists have the highest level of training and experience in medical dermatology, to provide collaborative optimum care for hospitalized patients with dermatological diseases.
Tay
L K
LK
Department of Dermatology, Singapore General Hospital, Singapore City, Singapore. drtay01@yahoo.com.sg
Lee
H Y
HY
Thirumoorthy
T
T
Pang
S M
SM
D000328:Adult; D017677:Age Distribution; D000368:Aged; D002983:Clinical Competence; D015897:Comorbidity; D003880:Dermatology / Q000458:organization & administration*; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006302:Health Services Research / Q000379:methods; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008511:Medicine / Q000706:statistics & numerical data; D008875:Middle Aged; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012846:Singapore; D012871:Skin Diseases / Q000175:diagnosis