Unique populations among those seeking emergency care for dermatologic problems

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1. In the United States, the number of visits to the emergency room (ER) due to skin symptoms is rising. 

2. A patient given a primary dermatologic diagnosis upon discharge from the ER was more likely to be Caucasian or Native American, uninsured, male, and of low socioeconomic status. 

Evidence Rating Level: 2 (Good)

Study Rundown: In the United States, emergency room (ER) visits are becoming more common. Likewise, ER visits due to dermatologic complaints have risen by 2.5 million in the past decade and now comprise 4.2% of all emergency visits. These authors sought to determine the prevalence of particular skin pathologies leading to emergent medical attention and to characterize this demographic of patients. Authors found that patients with a dermatologic primary diagnosis were more likely male, Caucasian or Native American, uninsured, low income, and to visit on the weekend. Identification of this information may lead to further studies about optimizing emergency services for this demographic. A strength of this study was its large sample size. However, only data from California was collected, which may limit the generalization of the results.

Click to read the study in the Journal of American Academy of Dermatology

Relevant reading: Dermatological conditions presenting at the Emergency Department in Siena University Hospital from 2006 to 2011

In-Depth [retrospective cohort]: Records of patients discharged from California ERs from 2005 to 2011 were analyzed, using ICD-9 codes to classify diagnoses. A total of 46,188,747 patient records were screened, yielding 2,078,660 cases with dermatologic primary diagnoses. Of these individuals, multivariate logistic regression was employed to compare demographic data between those with and without primary dermatologic diagnoses. It was found that <18 years (OR 0.83 95% CI 0.83-0.84, P<0.001), >54 years (OR 0.70, 95% CI 0.70-0.71, P<0.001), Black (OR 0.92 95% CI 0.91-0.92, P<0.001), Hispanic (OR 0.88 95% CI 0.88-0.89, P<0.001), and Asian (OR 0.79, 95% CI 0.79-0.80, P<0.001) patients were less likely to be discharged with a dermatologic primary diagnosis. Whereas, male (OR 1.34 95% CI 1.33-1.34, P<0.001), uninsured (OR 1.54, 95% CI 1.54-1.55, P <0.001) and weekend (OR 1.07, 95% CI 1.07-1.08, P <0.001) patients had a higher likelihood of a primary dermatologic diagnosis in the ED.

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