122 - Characteristics of Pediatric Visits to the Emergency Department with Dermatological Complaints

Publication Number: 122.4138

Tomas Leng, Mayo Clinic, Rochester, MN, United States; Katherine Homme, Mayo Clinic Children's Center, Rochester, MN, United States; James Homme, Mayo Clinic Children's Center, Rocheseter, MN, United States

Background: Dermatological diseases constitute 4%–12% of all emergency department (ED) visits and may contribute to high health care costs. Previous research has indicated that the use of digital photography in clinical settings may improve efficacy and diagnostic accuracy. However, little is known about pediatric visits in the ED.

Objective: The aim of this study is to determine characteristics, photo app utilization and diagnostic concordance at follow-up of pediatric visits to the ED with dermatological complaints.

Design/Methods: Retrospective study conducted in the ED at a university hospital. Patients ≤ 18 years of age who presented with a dermatologic concern between May 2022–April 2023, were included. The collected variables included demographics, triage categories, chief complaints, photo app utilization rate, ED workup and treatments, consultations, final diagnoses, disposition, follow-up visits and diagnostic concordance at a follow visit. A multivariable regression model was constructed to examine the effect of factors associated with the photo app use in the ED.

Results: A total of 380 patients were included in the final analysis with a median age of four. The most common final diagnoses were rash (21%, N = 80), burn (9%, N = 35), and cellulitis (9%, N = 35). Fourteen patients (4%) had an emergent triage category (ESI 2). Only 5% (N = 20) of visits resulted in admission. Photo app was used in 38% (N = 143) encounters. White race (OR 1.73; 95% CI 1.08 to 2.74), ESI triage category 2 (OR 3.12; 95% CI 1.02 to 9.50), duration of illness > 1 week (OR 2.65; 95% CI 1.35 to 5.20), and burns (OR 2.12; 95% CI 1.05 to 4.26) were associated with the photo app use. Consultation was requested in 21% (N = 79) of encounters: 42% (N = 33) in person and 38% (N = 30) E-consult. Overall, 30% (N = 113) of patients attended a follow-up visit. Only 52% (N=59) of patients with a follow-up ordered or specifically recommended upon discharge (30%, N=114) were compliant. Follow-up care was sought in 20% (N = 54) of cases where no order or specific recommendation was made. The diagnosis at follow-up was identical in 69% (N = 78) of cases; clarified for 21% (N = 25) and altered in eleven patients (10%).

Conclusion(s): Most pediatric visits presenting to the ED with dermatological complaints are non-urgent and ER physicians independently manage the majority of these cases. White race, ESI 2, illness duration > 1 week and burns were associated with the photo app use. Follow-up occurred in 30% of cases where a high degree of diagnostic accuracy (69%) was identified.