[Evaluation of dermatology consultations in a prospective multicenter study involving a French teaching hospital].

BACKGROUND: Dermatologic practice occurs mainly in the inpatient setting. This activity is also referred to as consultation-liaison dermatology (DL). STUDY AIMS: To describe and quantify this dermatologic consultation activity in a hospital setting in Marseille; to establish the relationship between presumptive dermatologic diagnosis and the final diagnosis retained by the dermatologist. PATIENTS AND METHODS: This was a prospective study carried out three university teaching hospitals and an army teaching hospital for a period of three months. Of particular note is that services requesting consultation were asked in each case to supply their presumptive dermatologic diagnosis at the time consultation was requested. The statistical analysis was carried out using the SPSS 15.0 software package. A total of 352 notes for dermatology consultations were requested and 336 of these were evaluated, representing 5% of all consultations activities within these dermatology departments over this period. Ninety-three percent of the consultations were established by dermatology interns and 86% of consultations took place within 24 hours following their demand. Thirty-one percent of consultations were for patients aged over 75 years and 61% of the requests emanated from medical departments. The main requests concerned elementary lesions, symptoms or non-specific eruptions (56%), recommendations for treating infectious skin diseases (17%), inflammatory diseases (7%) and skin cancer (5%), recommendations for nursing care (14%) and the remainder for various reasons. No diagnosis was established in the face of of non-specific signs in 26.4% of cases. The diagnosis made by dermatologists differed from that initially evoked by the non-specialists in 56.3% of cases. Initial dermatological diagnosis was least successful regarding drug-induced eruption and skin cancer. The majority of consultations (57%) were considered unrelated to the patients' previous histories or reasons for admission. Twenty-six percent of patients were prescribed systemic therapy and 80% were prescribed topical treatment, of whom a quarter received dressings. Therapeutic acts were prescribed for 40% of the patients. Five percent of the patients were hospitalized after their consultation at the respective dermatology department and 14% were referred for outpatient dermatology consultations. DISCUSSION: This study confirms a number of expected features: common dermatological diseases are often not recognized or is misdiagnosed by non-dermatologists, excessive bedside consultations and very particular profiles of the common diagnoses in this activity (nursing care, drug-induced eruption, fungal infections). Less predictable were the absence of links between the requests and the moderate impact of the activity on hospitalization.
CONCLUSION: The study of these dermatologic diagnoses in an in-patient setting suggests a number of approaches to more successful management of these consultations.