Factors related to missed diagnosis of incidental scabies infestations in patients admitted through the emergency department to inpatient services.
OBJECTIVE
Scabies is highly contagious and requires prompt diagnosis and implementation of infection control measures to prevent transmission and outbreaks. This study investigated the clinical and administrative correlates associated with missed diagnosis of scabies in an emergency department (ED).


METHODS
This was a retrospective study of patients with incidental scabies infestations who were admitted to a university hospital via the ED during a 4-year period.


RESULTS
A total of 135 inpatients were identified as having scabies; among them, 111 patients (82%) had visited the ED. Scabies were diagnosed during the ED stay in 39 of 111 patients (35%), while the diagnosis was missed in the ED in 72 patients (65%). Although no geographic clusters suggestive of nosocomial scabies transmission were registered, 160 medical workers and one hospitalized patient received prophylactic treatment due to direct skin-to-skin contact with inpatient scabies cases during the study period. Overcrowding (odds ratio [OR] = 8.4; 95% confidence interval [CI] = 1.9 to 38.0) and time constraints (OR = 8.2; 95% CI = 1.9 to 34.7) in the ED were associated with a missed diagnosis of scabies during ED stay. Patients with lower illness severity scores were at higher risk for failure to diagnose and to treat scabies prior to hospital admission (OR = 5.7; 95% CI = 1.6 to 20.9).


CONCLUSIONS
Missed diagnoses of scabies during ED stay may result in nosocomial spread and increase the unnecessary use of prophylactic treatments. ED overcrowding, time constraints, and less severe illness compromise ED recognition of scabies. Health care workers should be especially alert for signs of scabies infestations under these conditions.
Hong
Ming-Yuan
MY
Department of Emergency Medicine, National Cheng-Kung University Hospital, Tainan, Taiwan.
Lee
Ching-Chi
CC
Chuang
Ming-Che
MC
Chao
Sheau-Chiou
SC
Tsai
Ming-Che
MC
Chi
Chih-Hsien
CH
D000368:Aged; D000369:Aged, 80 and over; D003428:Cross Infection / Q000453:epidemiology / Q000469:parasitology* / Q000635:transmission; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000592:standards; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012532:Scabies / Q000175:diagnosis* / Q000453:epidemiology*; D013624:Taiwan / Q000453:epidemiology