Details

Autor(en) / Beteiligte

• Alba‐Rojas, Erika L.
• Morán‐Villaseñor, Edna
• Campos‐Cabrera, Blanca L.
• Aguirre‐Martínez, Iliana L.
• Vega‐Rangel, Rosa V.
• Cazares‐Ramírez, Eduardo
• Medina‐Vera, Isabel
• García‐Romero, María Teresa

Titel

Diagnostic concordance between pediatric emergency department physicians and dermatologists in a tertiary hospital in Mexico

Ist Teil von

• Pediatric dermatology, 2020-11, Vol.37 (6), p.1113-1118

Ort / Verlag

United States: Wiley Subscription Services, Inc

Erscheinungsjahr

2020

Quelle

Wiley Online Library Journals Frontfile Complete

Beschreibungen/Notizen

• Background and Objectives Skin diseases are a common reason for emergency department (ED) consultations; however, few studies have focused on pediatric patients. Diagnostic consistency between ED physicians and dermatologists varies from 43% to 58%, meaning many patients seeking emergency care may receive incorrect diagnoses and treatments. We aimed to determine the diagnostic concordance between ED physicians and pediatric dermatologists. Methods We conducted a prospective study including all pediatric patients (<18 years) who were seen for a skin condition at the ED from December 1, 2017, to June 1, 2018, and consented to participate. We classified diagnoses according to their etiology. Patients were diagnosed by ED trainees and attending physicians, followed by blinded pediatric dermatology trainees and attending physicians. We evaluated concordance using Fleiss's kappa coefficient (κ) with a 95% confidence interval. We further stratified the data by level of training. Results We included 185 patients. Inflammatory conditions were the most common reason for consultation, followed by infections; 10 patients required hospitalization. Concordance between diagnoses given at the ED and at the dermatology clinic was moderate (κ 0.472, 95% CI: 0.389‐0.455) with 62.7% agreement. Concordance between different diagnostic categories was lowest for autoimmune disorders and drug reactions (κ 0.392 with 95% CI: 0.248‐0.536 and κ 0.258 with 95% CI: 0.114‐0.402). Conclusions Diagnostic concordance between ED physicians and dermatologists was moderate and differed according to training level and diagnoses. Dermatological education for ED providers, specifically focusing on autoimmune disorders and drug reactions, may improve diagnostic accuracy and patient care.